|
INSULIN GLARGINE (LANTUS) GLUCOMMANDER 100 UNIT/ML SUBCUTANEOUS [408177]
|
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 |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| 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 (LANTUS) GLUCOMMANDER 100 UNIT/ML SUBCUTANEOUS [408177]
|
Facility
|
OP
|
$7.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| 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 |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cash Price |
$3.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| 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 GLARGINE (LANTUS) GLUCOMMANDER 100 UNIT/ML SUBCUTANEOUS TRANSITIONAL [408206]
|
Facility
|
OP
|
$7.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| 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 |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cash Price |
$3.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| 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 GLARGINE (LANTUS) GLUCOMMANDER 100 UNIT/ML SUBCUTANEOUS TRANSITIONAL [408206]
|
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 |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| 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
|
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 |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| 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 |
$9.27 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| 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 |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cash Price |
$3.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| 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 0088250033
|
| 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 |
$5.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.86
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cigna of CA HMO |
$7.15
|
| Rate for Payer: Cigna of CA PPO |
$7.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| 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 0088250033
|
| 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 |
$6.56
|
| Rate for Payer: Cash Price |
$4.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$6.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.03
|
| 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 REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| 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 |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| 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 |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
|
|
INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION [225937]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| 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: Cash Price |
$0.19
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| 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 |
$0.21
|
| 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 |
$0.16
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.14
|
| 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 HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
|
OP
|
$114.84
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Adventist Health Commercial |
$22.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: EPIC Health Plan Senior |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.39
|
| Rate for Payer: Multiplan Commercial |
$91.87
|
| Rate for Payer: Networks By Design Commercial |
$57.42
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.10
|
| Rate for Payer: United Healthcare All Other HMO |
$41.95
|
| Rate for Payer: United Healthcare HMO Rider |
$41.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.61
|
| Rate for Payer: Vantage Medical Group Senior |
$97.61
|
|
|
INSULIN REGULAR HUMAN U-500 "CONCENTRATE" 500 UNIT/ML(3 ML) SUBCUT PEN [213661]
|
Facility
|
IP
|
$114.84
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Adventist Health Commercial |
$22.97
|
| Rate for Payer: Blue Shield of California Commercial |
$58.22
|
| Rate for Payer: Blue Shield of California Commercial |
$88.31
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cigna of CA HMO |
$80.39
|
| Rate for Payer: Cigna of CA PPO |
$80.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.94
|
| Rate for Payer: EPIC Health Plan Senior |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$97.61
|
| Rate for Payer: Global Benefits Group Commercial |
$68.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.56
|
| Rate for Payer: Multiplan Commercial |
$91.87
|
| Rate for Payer: Networks By Design Commercial |
$57.42
|
| Rate for Payer: Prime Health Services Commercial |
$97.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.10
|
| Rate for Payer: United Healthcare All Other HMO |
$41.95
|
| Rate for Payer: United Healthcare HMO Rider |
$41.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.61
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [10289]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| 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 |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cigna of CA HMO |
$3.75
|
| Rate for Payer: Cigna of CA PPO |
$3.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.75
|
| 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 |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.16
|
| 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 |
$2.67
|
| 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 |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
| 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 U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION [10289]
|
Facility
|
IP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cigna of CA HMO |
$3.75
|
| Rate for Payer: Cigna of CA PPO |
$3.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.75
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.16
|
| 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 |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.75
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$11,915.34
|
|
|
Service Code
|
APR-DRG 8172
|
| Min. Negotiated Rate |
$9,516.59 |
| Max. Negotiated Rate |
$11,915.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,516.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,915.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,661.09
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$8,350.54
|
|
|
Service Code
|
APR-DRG 8171
|
| Min. Negotiated Rate |
$6,669.44 |
| Max. Negotiated Rate |
$8,350.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,669.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,350.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,471.53
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$58,032.84
|
|
|
Service Code
|
APR-DRG 8174
|
| Min. Negotiated Rate |
$46,349.91 |
| Max. Negotiated Rate |
$58,032.84 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46,349.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58,032.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,924.12
|
|
|
INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
IP
|
$22,027.88
|
|
|
Service Code
|
APR-DRG 8173
|
| Min. Negotiated Rate |
$17,593.32 |
| Max. Negotiated Rate |
$22,027.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,593.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,027.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,709.15
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$17,147.01
|
|
|
Service Code
|
APR-DRG 1422
|
| Min. Negotiated Rate |
$13,695.04 |
| Max. Negotiated Rate |
$17,147.01 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,695.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,147.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,342.06
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$25,114.12
|
|
|
Service Code
|
APR-DRG 1423
|
| Min. Negotiated Rate |
$20,058.25 |
| Max. Negotiated Rate |
$25,114.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,058.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,114.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,470.53
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$13,041.07
|
|
|
Service Code
|
APR-DRG 1421
|
| Min. Negotiated Rate |
$10,415.70 |
| Max. Negotiated Rate |
$13,041.07 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,041.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,668.32
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$51,233.44
|
|
|
Service Code
|
APR-DRG 1424
|
| Min. Negotiated Rate |
$40,919.34 |
| Max. Negotiated Rate |
$51,233.44 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,919.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51,233.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,840.45
|
|
|
INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
|
IP
|
$96,091.21
|
|
|
Service Code
|
MSDRG 197
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,091.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,772.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,091.21
|
| Rate for Payer: EPIC Health Plan Senior |
$64,060.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,237.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,531.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,037.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
|
IP
|
$112,737.65
|
|
|
Service Code
|
MSDRG 196
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$112,737.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,212.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$112,737.65
|
| Rate for Payer: EPIC Health Plan Senior |
$75,158.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,325.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95,656.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,556.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$91,958.46
|
|
|
Service Code
|
MSDRG 198
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,958.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,712.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,958.46
|
| Rate for Payer: EPIC Health Plan Senior |
$61,305.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,732.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$78,025.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,681.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
