|
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 |
$3.53 |
| Max. Negotiated Rate |
$16.57 |
| Rate for Payer: Adventist Health Commercial |
$3.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.62
|
| Rate for Payer: Blue Shield of California Commercial |
$12.10
|
| Rate for Payer: Blue Shield of California EPN |
$11.44
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.57
|
| Rate for Payer: Dignity Health Senior |
$16.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.06
|
| Rate for Payer: Heritage Provider Network Senior |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$14.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.57
|
| Rate for Payer: Vantage Medical Group Senior |
$16.57
|
|
|
FENTANYL 1,600 MCG LOZENGE ON A HANDLE [27918]
|
Facility
OP
|
$43.11
|
|
|
Service Code
|
NDC 0406-9216-30
|
| Hospital Charge Code |
1730151
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$36.64 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.33
|
| Rate for Payer: Blue Shield of California Commercial |
$26.77
|
| Rate for Payer: Blue Shield of California EPN |
$25.31
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.64
|
| Rate for Payer: Dignity Health Senior |
$36.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.69
|
| Rate for Payer: Heritage Provider Network Senior |
$26.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.78
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
| 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 |
$7.80 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: Cash Price |
$19.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.19
|
| Rate for Payer: Heritage Provider Network Senior |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.78
|
| Rate for Payer: Multiplan Commercial |
$32.33
|
|
|
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 |
$2.65 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.96
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.58
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.43
|
| Rate for Payer: Dignity Health Senior |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.05
|
| Rate for Payer: Heritage Provider Network Senior |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$10.96
|
| 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 |
$2.65 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.04
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$10.96
|
|
|
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 |
$1.55 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.88
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
|
|
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 |
$1.55 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.02
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.28
|
| Rate for Payer: Dignity Health Senior |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.30
|
| Rate for Payer: Heritage Provider Network Senior |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7.28
|
|
|
FENTANYL 400 MCG LOZENGE ON A HANDLE [27914]
|
Facility
IP
|
$18.53
|
|
|
Service Code
|
NDC 0406-9204-30
|
| Hospital Charge Code |
1730147
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.54
|
| Rate for Payer: Heritage Provider Network Senior |
$12.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
|
|
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 |
$3.35 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Blue Shield of California Commercial |
$11.51
|
| Rate for Payer: Blue Shield of California EPN |
$10.88
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Senior |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.47
|
| Rate for Payer: Heritage Provider Network Senior |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$15.75
|
|
|
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 |
$2.75 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Adventist Health Commercial |
$3.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.44
|
| Rate for Payer: Blue Shield of California EPN |
$8.92
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.92
|
| Rate for Payer: Dignity Health Senior |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.41
|
| Rate for Payer: Heritage Provider Network Senior |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
| 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 0406-9150-76
|
| Hospital Charge Code |
1737053
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Adventist Health Commercial |
$3.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.44
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Senior |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
|
|
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 |
$2.75 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Adventist Health Commercial |
$3.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.44
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.29
|
| Rate for Payer: Heritage Provider Network Senior |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
|
|
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 |
$2.75 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Adventist Health Commercial |
$3.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.44
|
| Rate for Payer: Blue Shield of California EPN |
$8.92
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.92
|
| Rate for Payer: Dignity Health Senior |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.41
|
| Rate for Payer: Heritage Provider Network Senior |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$11.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.92
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]
|
Facility
OP
|
$24.02
|
|
|
Service Code
|
NDC 0378-9123-16
|
| Hospital Charge Code |
1737054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$14.10
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.42
|
| Rate for Payer: Dignity Health Senior |
$20.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.87
|
| Rate for Payer: Heritage Provider Network Senior |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.42
|
| Rate for Payer: Vantage Medical Group Senior |
$20.42
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]
|
Facility
IP
|
$24.02
|
|
|
Service Code
|
NDC 0378-9123-16
|
| Hospital Charge Code |
1737054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.50
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.02
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]
|
Facility
IP
|
$24.02
|
|
|
Service Code
|
NDC 0378-9123-98
|
| Hospital Charge Code |
1737054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.50
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.02
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]
|
Facility
OP
|
$24.02
|
|
|
Service Code
|
NDC 0378-9123-98
|
| Hospital Charge Code |
1737054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$14.10
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.42
|
| Rate for Payer: Dignity Health Senior |
$20.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.87
|
| Rate for Payer: Heritage Provider Network Senior |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.42
|
| Rate for Payer: Vantage Medical Group Senior |
$20.42
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]
|
Facility
OP
|
$24.02
|
|
|
Service Code
|
NDC 0406-9175-76
|
| Hospital Charge Code |
1737054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California EPN |
$14.10
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.42
|
| Rate for Payer: Dignity Health Senior |
$20.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.87
|
| Rate for Payer: Heritage Provider Network Senior |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.42
|
| Rate for Payer: Vantage Medical Group Senior |
$20.42
|
|
|
FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]
|
Facility
IP
|
$24.02
|
|
|
Service Code
|
NDC 0406-9175-76
|
| Hospital Charge Code |
1737054
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.50
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.02
|
|
|
FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX ADULT [4081452]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 71286-2081-1
|
| Hospital Charge Code |
NDG2569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX ADULT [4081452]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 71286-2081-1
|
| Hospital Charge Code |
NDG2569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Senior |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX PEDS [117212]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 71286-2081-1
|
| Hospital Charge Code |
NDG2569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Senior |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX PEDS [117212]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 70004-244-40
|
| Hospital Charge Code |
NDG2569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX PEDS [117212]
|
Facility
IP
|
$0.18
|
|
|
Service Code
|
NDC 71286-2081-1
|
| Hospital Charge Code |
NDG2569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
FENTANYL-BUPIVACAINE 2 MCG/ML-0.0625% EPIDURAL PREMIX PEDS [117212]
|
Facility
OP
|
$0.18
|
|
|
Service Code
|
NDC 70004-244-40
|
| Hospital Charge Code |
NDG2569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Senior |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
