|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cigna of CA HMO |
$1,086.08
|
| Rate for Payer: Cigna of CA PPO |
$1,255.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,018.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.40 |
| Max. Negotiated Rate |
$1,518.95 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.80
|
| Rate for Payer: EPIC Health Plan Senior |
$714.80
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.88
|
| Rate for Payer: Multiplan Commercial |
$1,429.60
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cigna of CA HMO |
$1,143.68
|
| Rate for Payer: Cigna of CA PPO |
$1,322.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,191.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,429.60
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,072.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [114723]
|
Facility
|
OP
|
$8.68
|
|
|
Service Code
|
NDC 0169-3685-12
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.33
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.94
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.38
|
| Rate for Payer: Vantage Medical Group Senior |
$7.38
|
|
|
INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [114723]
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
NDC 0169-3685-12
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.94
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]
|
Facility
|
OP
|
$8.68
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.33
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.94
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.38
|
| Rate for Payer: Vantage Medical Group Senior |
$7.38
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.94
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
IP
|
$40.67
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Blue Shield of California Commercial |
$30.01
|
| Rate for Payer: Blue Shield of California EPN |
$19.77
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$20.34
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO |
$14.86
|
| Rate for Payer: United Healthcare HMO Rider |
$14.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.32
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
OP
|
$40.67
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$20.34
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO |
$14.86
|
| Rate for Payer: United Healthcare HMO Rider |
$14.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
|
IP
|
$7.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.55 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.75
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$6.17
|
| Rate for Payer: Networks By Design Commercial |
$3.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.53
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
|
OP
|
$7.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$6.17
|
| Rate for Payer: Networks By Design Commercial |
$3.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6.55
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.97
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$7.15
|
| Rate for Payer: Cigna of CA PPO |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.09
|
| Rate for Payer: EPIC Health Plan Senior |
$4.09
|
| Rate for Payer: Galaxy Health WC |
$8.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Multiplan Commercial |
$8.18
|
| Rate for Payer: Networks By Design Commercial |
$6.64
|
| Rate for Payer: Prime Health Services Commercial |
$8.69
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.28
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cigna of CA HMO |
$7.15
|
| Rate for Payer: Cigna of CA PPO |
$7.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.09
|
| Rate for Payer: EPIC Health Plan Senior |
$4.09
|
| Rate for Payer: Galaxy Health WC |
$8.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$8.18
|
| Rate for Payer: Networks By Design Commercial |
$6.64
|
| Rate for Payer: Prime Health Services Commercial |
$8.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare HMO Rider |
$5.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.69
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [87889]
|
Facility
|
IP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [87889]
|
Facility
|
OP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.45
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cigna of CA HMO |
$17.15
|
| Rate for Payer: Cigna of CA PPO |
$19.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$21.43
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
|
|
INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]
|
Facility
|
IP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
|
|
INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$3.42
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.55
|
|
|
INSULIN LISPRO VIAL (HUMALOG, ADMELOG) 100 UNIT/ML SUBCUTANEOUS [17405]
|
Facility
|
OP
|
$15.69
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna of CA HMO |
$10.04
|
| Rate for Payer: Cigna of CA HMO |
$7.53
|
| Rate for Payer: Cigna of CA PPO |
$11.61
|
| Rate for Payer: Cigna of CA PPO |
$8.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Networks By Design Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.84
|
| Rate for Payer: United Healthcare All Other HMO |
$7.84
|
| Rate for Payer: United Healthcare All Other HMO |
$5.88
|
| Rate for Payer: United Healthcare HMO Rider |
$7.84
|
| Rate for Payer: United Healthcare HMO Rider |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13.34
|
|
|
INSULIN LISPRO VIAL (HUMALOG, ADMELOG) 100 UNIT/ML SUBCUTANEOUS [17405]
|
Facility
|
IP
|
$11.77
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Multiplan Commercial |
$9.42
|
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: Galaxy Health WC |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Networks By Design Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$13.34
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION [10284]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.61
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna of CA HMO |
$3.42
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.55
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION [10284]
|
Facility
|
IP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.28
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 0338-0126-12
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.34
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
INSULIN REGULAR 1 UNIT/ML 5 ML IV SYRINGE [40820142]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 9940-8201-41
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
INSULIN REGULAR 1 UNIT/ML 5 ML IV SYRINGE [40820142]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 9940-8201-41
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.11
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.12
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
