|
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 |
$0.16 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.50
|
| 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 Exchange |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.48
|
| Rate for Payer: Blue Distinction Transplant |
$0.49
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Central Health Plan Commercial |
$0.66
|
| 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 Management Network EPO/PPO |
$0.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.29
|
| 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 |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$0.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.33
|
| 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 Medi-Cal |
$0.70
|
| Rate for Payer: Vantage Medical Group Senior |
$0.70
|
|
|
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 |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| 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 Exchange |
$0.63
|
| 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 |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| 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 Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.46
|
| 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 |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| 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 Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
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 |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| 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: Health Management Network EPO/PPO |
$0.23
|
| 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 |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| 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
|
$0.27
|
|
|
Service Code
|
NDC 27241-116-03
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| 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: Health Management Network EPO/PPO |
$0.24
|
| 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 |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| 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
|
$1.30
|
|
|
Service Code
|
NDC 68084-827-95
|
| Hospital Charge Code |
1712510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| 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 Exchange |
$0.63
|
| 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 |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| 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 Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.46
|
| 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 |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| 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 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 |
$0.05 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| 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 Exchange |
$0.13
|
| 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 |
$0.17
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.22
|
| 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 Management Network EPO/PPO |
$0.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.09
|
| 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 |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.23
|
| Rate for Payer: Riverside University Health System MISP |
$0.11
|
| 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 Medi-Cal |
$0.23
|
| Rate for Payer: Vantage Medical Group Senior |
$0.23
|
|
|
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 |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| 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: Health Management Network EPO/PPO |
$1.17
|
| 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 |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
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 |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Blue Shield of California Commercial |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| 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: Health Management Network EPO/PPO |
$1.17
|
| 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 |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
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 |
$119.50 |
| Max. Negotiated Rate |
$537.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$362.85
|
| 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 Exchange |
$289.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.99
|
| Rate for Payer: Blue Distinction Transplant |
$358.49
|
| Rate for Payer: Blue Shield of California Commercial |
$375.81
|
| Rate for Payer: Blue Shield of California EPN |
$292.17
|
| Rate for Payer: Cash Price |
$268.87
|
| Rate for Payer: Central Health Plan Commercial |
$477.98
|
| 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 Management Network EPO/PPO |
$537.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$448.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$209.12
|
| 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 |
$119.50
|
| Rate for Payer: Multiplan Commercial |
$448.11
|
| Rate for Payer: Networks By Design Commercial |
$388.36
|
| Rate for Payer: Prime Health Services Commercial |
$507.86
|
| Rate for Payer: Riverside University Health System MISP |
$238.99
|
| 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 Medi-Cal |
$507.86
|
| Rate for Payer: Vantage Medical Group Senior |
$507.86
|
|
|
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 |
$119.50 |
| Max. Negotiated Rate |
$537.73 |
| Rate for Payer: Blue Shield of California Commercial |
$448.11
|
| Rate for Payer: Blue Shield of California EPN |
$319.05
|
| Rate for Payer: Cash Price |
$268.87
|
| Rate for Payer: Central Health Plan Commercial |
$477.98
|
| 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: Health Management Network EPO/PPO |
$537.73
|
| 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 |
$119.50
|
| Rate for Payer: Multiplan Commercial |
$448.11
|
| Rate for Payer: Networks By Design Commercial |
$388.36
|
| Rate for Payer: Prime Health Services Commercial |
$507.86
|
|
|
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 |
$6.61 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.08
|
| 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 Exchange |
$16.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.54
|
| Rate for Payer: Blue Distinction Transplant |
$19.84
|
| Rate for Payer: Blue Shield of California Commercial |
$20.80
|
| Rate for Payer: Blue Shield of California EPN |
$16.17
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.46
|
| 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 Management Network EPO/PPO |
$29.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.57
|
| 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 |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$21.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.11
|
| Rate for Payer: Riverside University Health System MISP |
$13.23
|
| 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 Medi-Cal |
$28.11
|
| Rate for Payer: Vantage Medical Group Senior |
$28.11
|
|
|
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 |
$6.61 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Blue Shield of California Commercial |
$24.80
|
| Rate for Payer: Blue Shield of California EPN |
$17.66
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Central Health Plan Commercial |
$26.46
|
| 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: Health Management Network EPO/PPO |
$29.76
|
| 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 |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$21.50
|
| Rate for Payer: Prime Health Services Commercial |
$28.11
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]
|
Facility
|
OP
|
$19.49
|
|
|
Service Code
|
NDC 0406-9112-76
|
| Hospital Charge Code |
1730786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$17.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.84
|
| 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 Exchange |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.51
|
| Rate for Payer: Blue Distinction Transplant |
$11.69
|
| Rate for Payer: Blue Shield of California Commercial |
$12.26
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Central Health Plan Commercial |
$15.59
|
| 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 Management Network EPO/PPO |
$17.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.82
|
| 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 |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
| Rate for Payer: Riverside University Health System MISP |
$7.80
|
| 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 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 0406-9112-76
|
| Hospital Charge Code |
1730786
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$17.54 |
| Rate for Payer: Blue Shield of California Commercial |
$14.62
|
| Rate for Payer: Blue Shield of California EPN |
$10.41
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Central Health Plan Commercial |
$15.59
|
| 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: Health Management Network EPO/PPO |
$17.54
|
| 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 |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Networks By Design Commercial |
$12.67
|
| Rate for Payer: Prime Health Services Commercial |
$16.57
|
|
|
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 |
$8.62 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.18
|
| 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 Exchange |
$20.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.47
|
| Rate for Payer: Blue Distinction Transplant |
$25.87
|
| Rate for Payer: Blue Shield of California Commercial |
$27.12
|
| Rate for Payer: Blue Shield of California EPN |
$21.08
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Central Health Plan Commercial |
$34.49
|
| 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 Management Network EPO/PPO |
$38.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.09
|
| 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 |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$36.64
|
| Rate for Payer: Riverside University Health System MISP |
$17.24
|
| 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 Medi-Cal |
$36.64
|
| Rate for Payer: Vantage Medical Group Senior |
$36.64
|
|
|
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 |
$8.62 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Blue Shield of California Commercial |
$32.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.02
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Central Health Plan Commercial |
$34.49
|
| 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: Health Management Network EPO/PPO |
$38.80
|
| 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 |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$2.92 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.88
|
| 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 Exchange |
$7.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.64
|
| Rate for Payer: Blue Distinction Transplant |
$8.77
|
| Rate for Payer: Blue Shield of California Commercial |
$9.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$11.70
|
| 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 Management Network EPO/PPO |
$13.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.12
|
| 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 |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$10.96
|
| Rate for Payer: Networks By Design Commercial |
$9.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.43
|
| Rate for Payer: Riverside University Health System MISP |
$5.85
|
| 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 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 |
$2.92 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Blue Shield of California Commercial |
$10.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.81
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$11.70
|
| 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: Health Management Network EPO/PPO |
$13.16
|
| 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 |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$10.96
|
| 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
|
OP
|
$8.56
|
|
|
Service Code
|
NDC 0406-9125-76
|
| Hospital Charge Code |
1737052
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.20
|
| 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 Exchange |
$4.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.06
|
| Rate for Payer: Blue Distinction Transplant |
$5.14
|
| Rate for Payer: Blue Shield of California Commercial |
$5.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.19
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Central Health Plan Commercial |
$6.85
|
| 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 Management Network EPO/PPO |
$7.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.00
|
| 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 |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
| Rate for Payer: Riverside University Health System MISP |
$3.42
|
| 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 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 0406-9125-76
|
| Hospital Charge Code |
1737052
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Blue Shield of California Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Central Health Plan Commercial |
$6.85
|
| 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: Health Management Network EPO/PPO |
$7.70
|
| 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 |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Networks By Design Commercial |
$5.56
|
| Rate for Payer: Prime Health Services Commercial |
$7.28
|
|
|
FENTANYL 400 MCG LOZENGE ON A HANDLE [27914]
|
Facility
|
OP
|
$18.53
|
|
|
Service Code
|
NDC 0406-9204-30
|
| Hospital Charge Code |
1730147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Blue Distinction Transplant |
$11.12
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.06
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.82
|
| Rate for Payer: Cigna of CA HMO |
$12.97
|
| Rate for Payer: Cigna of CA PPO |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.75
|
| Rate for Payer: Dignity Health Media |
$15.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$15.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.49
|
| 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 |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
| Rate for Payer: Riverside University Health System MISP |
$7.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.26
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$15.75
|
|
|
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 |
$3.71 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Blue Shield of California Commercial |
$13.90
|
| Rate for Payer: Blue Shield of California EPN |
$9.90
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.82
|
| 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: Health Management Network EPO/PPO |
$16.68
|
| 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 |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 0406-9050-76
|
| Hospital Charge Code |
1737053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.98
|
| Rate for Payer: Blue Distinction Transplant |
$9.12
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Blue Shield of California EPN |
$7.43
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Central Health Plan Commercial |
$12.16
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Media |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
| Rate for Payer: Riverside University Health System MISP |
$6.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.92
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
NDC 0406-9050-76
|
| Hospital Charge Code |
1737053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Blue Shield of California Commercial |
$11.40
|
| Rate for Payer: Blue Shield of California EPN |
$8.12
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Central Health Plan Commercial |
$12.16
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 0406-9150-76
|
| Hospital Charge Code |
1737053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.98
|
| Rate for Payer: Blue Distinction Transplant |
$9.12
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Blue Shield of California EPN |
$7.43
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Central Health Plan Commercial |
$12.16
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$10.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Media |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.08
|
| Rate for Payer: Galaxy Health WC |
$12.92
|
| Rate for Payer: Global Benefits Group Commercial |
$9.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
| Rate for Payer: Networks By Design Commercial |
$9.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.92
|
| Rate for Payer: Riverside University Health System MISP |
$6.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.60
|
| Rate for Payer: United Healthcare All Other HMO |
$7.60
|
| Rate for Payer: United Healthcare HMO Rider |
$7.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.92
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
