|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]
|
Facility
|
IP
|
$2.22
|
|
|
Service Code
|
NDC 6050570630
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Adventist Health Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.39
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Central Health Plan Commercial |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.93
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$1.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Galaxy Health WC |
$2.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$1.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$2.07
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$2.35
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 8770142790
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1.70
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
|
|
NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 8770142790
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.48
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$1.59
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.80
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1.80
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 4359844671
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Central Health Plan Commercial |
$1.65
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Prime Health Services Commercial |
$1.75
|
| Rate for Payer: Riverside University Health System MISP |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 4359844671
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Central Health Plan Commercial |
$1.65
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Prime Health Services Commercial |
$1.75
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
NDC 6050570610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 4898500155
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 4898500155
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.22
|
|
|
Service Code
|
NDC 6050570610
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 0536589488
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Central Health Plan Commercial |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$1.78
|
| Rate for Payer: Cigna of CA PPO |
$1.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Senior |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Prime Health Services Commercial |
$2.16
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 0536110688
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Central Health Plan Commercial |
$1.65
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Prime Health Services Commercial |
$1.75
|
| Rate for Payer: Riverside University Health System MISP |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1.03
|
| Rate for Payer: United Healthcare HMO Rider |
$1.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1.75
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 4359844674
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 0363019602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California EPN |
$1.20
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
| Rate for Payer: Riverside University Health System MISP |
$1.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.55
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 0536589488
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.61
|
| Rate for Payer: Blue Shield of California EPN |
$1.01
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Central Health Plan Commercial |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$1.78
|
| Rate for Payer: Cigna of CA PPO |
$1.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Senior |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Prime Health Services Commercial |
$2.16
|
| Rate for Payer: Riverside University Health System MISP |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2.16
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 4359844674
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.49
|
| Rate for Payer: Cigna of CA PPO |
$1.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
NDC 6050570880
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1.41
|
| Rate for Payer: Blue Shield of California EPN |
$0.89
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
| Rate for Payer: Riverside University Health System MISP |
$0.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1.89
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 0536110688
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.04
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Central Health Plan Commercial |
$1.65
|
| Rate for Payer: Cigna of CA HMO |
$1.44
|
| Rate for Payer: Cigna of CA PPO |
$1.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.34
|
| Rate for Payer: Prime Health Services Commercial |
$1.75
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$2.22
|
|
|
Service Code
|
NDC 6050570880
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Adventist Health Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.78
|
| Rate for Payer: Blue Shield of California EPN |
$1.12
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Central Health Plan Commercial |
$1.78
|
| Rate for Payer: Cigna of CA HMO |
$1.55
|
| Rate for Payer: Cigna of CA PPO |
$1.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.89
|
| Rate for Payer: EPIC Health Plan Senior |
$0.89
|
| Rate for Payer: Galaxy Health WC |
$1.89
|
| Rate for Payer: Global Benefits Group Commercial |
$1.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.44
|
| Rate for Payer: Multiplan Commercial |
$1.67
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Prime Health Services Commercial |
$1.89
|
|
|
NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 0363019602
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.41
|
| Rate for Payer: Blue Shield of California EPN |
$1.51
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Central Health Plan Commercial |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.60
|
| Rate for Payer: Multiplan Commercial |
$2.25
|
| Rate for Payer: Networks By Design Commercial |
$1.95
|
| Rate for Payer: Prime Health Services Commercial |
$2.55
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE [34769]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 4580234405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE [34769]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 4612273462
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE [34769]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 4580234403
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE [34769]
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
NDC 4612273408
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE [34769]
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
NDC 4612273408
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Central Health Plan Commercial |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.32
|
| Rate for Payer: Cigna of CA PPO |
$0.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: EPIC Health Plan Senior |
$0.18
|
| Rate for Payer: Galaxy Health WC |
$0.38
|
| Rate for Payer: Global Benefits Group Commercial |
$0.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.38
|
| Rate for Payer: Riverside University Health System MISP |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.23
|
| Rate for Payer: United Healthcare All Other HMO |
$0.23
|
| Rate for Payer: United Healthcare HMO Rider |
$0.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.38
|
| Rate for Payer: Vantage Medical Group Senior |
$0.38
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE [34769]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 4580234405
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
