|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
|
IP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$153.73
|
| Rate for Payer: Blue Shield of California Commercial |
$233.18
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.29
|
| Rate for Payer: EPIC Health Plan Senior |
$121.29
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.77
|
| Rate for Payer: Multiplan Commercial |
$242.58
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
|
OP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$1,199.79 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,199.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.67
|
| Rate for Payer: Blue Shield of California Commercial |
$205.92
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.59
|
| Rate for Payer: EPIC Health Plan Senior |
$129.06
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.22
|
| Rate for Payer: Multiplan Commercial |
$242.58
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Vantage Medical Group Senior |
$129.06
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$170.35
|
| Rate for Payer: Blue Shield of California Commercial |
$258.38
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$1,199.79 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,199.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.67
|
| Rate for Payer: Blue Shield of California Commercial |
$205.92
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.59
|
| Rate for Payer: EPIC Health Plan Senior |
$129.06
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.22
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Vantage Medical Group Senior |
$129.06
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
IP
|
$303.22
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$153.73
|
| Rate for Payer: Blue Shield of California Commercial |
$233.18
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.29
|
| Rate for Payer: EPIC Health Plan Senior |
$121.29
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.77
|
| Rate for Payer: Multiplan Commercial |
$242.58
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
IP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$257.74 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$153.73
|
| Rate for Payer: Blue Shield of California Commercial |
$233.18
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.29
|
| Rate for Payer: EPIC Health Plan Senior |
$121.29
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.77
|
| Rate for Payer: Multiplan Commercial |
$242.58
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
OP
|
$303.22
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$946.16 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$946.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.74
|
| Rate for Payer: Blue Shield of California Commercial |
$254.53
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.31
|
| Rate for Payer: EPIC Health Plan Senior |
$142.21
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$212.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.24
|
| Rate for Payer: Multiplan Commercial |
$242.58
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$129.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Vantage Medical Group Senior |
$142.21
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
OP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$1,199.79 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,199.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.67
|
| Rate for Payer: Blue Shield of California Commercial |
$205.92
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.59
|
| Rate for Payer: EPIC Health Plan Senior |
$129.06
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.22
|
| Rate for Payer: Multiplan Commercial |
$242.58
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Vantage Medical Group Senior |
$129.06
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [226952]
|
Facility
|
OP
|
$335.76
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$946.16 |
| Rate for Payer: Adventist Health Commercial |
$67.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$946.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.74
|
| Rate for Payer: Blue Shield of California Commercial |
$254.53
|
| Rate for Payer: Cash Price |
$151.09
|
| Rate for Payer: Cash Price |
$151.09
|
| Rate for Payer: Cigna of CA HMO |
$235.03
|
| Rate for Payer: Cigna of CA PPO |
$235.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.31
|
| Rate for Payer: EPIC Health Plan Senior |
$142.21
|
| Rate for Payer: Galaxy Health WC |
$285.40
|
| Rate for Payer: Global Benefits Group Commercial |
$201.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$212.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$180.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.24
|
| Rate for Payer: Multiplan Commercial |
$268.61
|
| Rate for Payer: Networks By Design Commercial |
$167.88
|
| Rate for Payer: Prime Health Services Commercial |
$285.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.01
|
| Rate for Payer: United Healthcare All Other HMO |
$122.65
|
| Rate for Payer: United Healthcare HMO Rider |
$120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$129.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Vantage Medical Group Senior |
$142.21
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [226952]
|
Facility
|
IP
|
$335.76
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$285.40 |
| Rate for Payer: Adventist Health Commercial |
$67.15
|
| Rate for Payer: Blue Shield of California Commercial |
$170.23
|
| Rate for Payer: Blue Shield of California Commercial |
$258.20
|
| Rate for Payer: Cash Price |
$151.09
|
| Rate for Payer: Cigna of CA HMO |
$235.03
|
| Rate for Payer: Cigna of CA PPO |
$235.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.30
|
| Rate for Payer: EPIC Health Plan Senior |
$134.30
|
| Rate for Payer: Galaxy Health WC |
$285.40
|
| Rate for Payer: Global Benefits Group Commercial |
$201.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.58
|
| Rate for Payer: Multiplan Commercial |
$268.61
|
| Rate for Payer: Networks By Design Commercial |
$167.88
|
| Rate for Payer: Prime Health Services Commercial |
$285.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.01
|
| Rate for Payer: United Healthcare All Other HMO |
$122.65
|
| Rate for Payer: United Healthcare HMO Rider |
$120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.96
|
|
|
GLUCOSE 50% FOR TPN [408002365]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
GLUCOSE 50% FOR TPN [408002365]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0574006930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0574006915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0574006930
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0574006915
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Senior |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
GLUTAMINE 15 GRAM ORAL POWDER PACKET [205214]
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 4390028300
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
|
|
GLUTAMINE 15 GRAM ORAL POWDER PACKET [205214]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 4390028300
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.46
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna of CA HMO |
$1.59
|
| Rate for Payer: Cigna of CA PPO |
$1.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1.93
|
|
|
GLUTAMINE (BULK) POWDER [13713]
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
NDC 3877924718
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
|
|
GLUTAMINE (BULK) POWDER [13713]
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
NDC 3877924719
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
|
|
GLUTAMINE (BULK) POWDER [13713]
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
NDC 9999013714
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.41
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna of CA HMO |
$17.36
|
| Rate for Payer: Cigna of CA PPO |
$20.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.99
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$13.56
|
| Rate for Payer: United Healthcare HMO Rider |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.06
|
| Rate for Payer: Vantage Medical Group Senior |
$23.06
|
|
|
GLUTAMINE (BULK) POWDER [13713]
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
NDC 3877924718
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.41
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna of CA HMO |
$17.36
|
| Rate for Payer: Cigna of CA PPO |
$20.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.99
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$13.56
|
| Rate for Payer: United Healthcare HMO Rider |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.06
|
| Rate for Payer: Vantage Medical Group Senior |
$23.06
|
|
|
GLUTAMINE (BULK) POWDER [13713]
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
NDC 9999013714
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
|
|
GLUTAMINE (BULK) POWDER [13713]
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
NDC 3877924719
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.41
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna of CA HMO |
$17.36
|
| Rate for Payer: Cigna of CA PPO |
$20.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.99
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$13.56
|
| Rate for Payer: United Healthcare HMO Rider |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.06
|
| Rate for Payer: Vantage Medical Group Senior |
$23.06
|
|
|
GLUTAMINE (UD) ORAL POWDER [4089100]
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
NDC 9999013715
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.41
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna of CA HMO |
$18.99
|
| Rate for Payer: Cigna of CA PPO |
$18.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.85
|
| Rate for Payer: EPIC Health Plan Senior |
$10.85
|
| Rate for Payer: Galaxy Health WC |
$23.06
|
| Rate for Payer: Global Benefits Group Commercial |
$16.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.99
|
| Rate for Payer: Multiplan Commercial |
$21.70
|
| Rate for Payer: Networks By Design Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Commercial |
$23.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Other HMO |
$13.56
|
| Rate for Payer: United Healthcare HMO Rider |
$13.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.06
|
| Rate for Payer: Vantage Medical Group Senior |
$23.06
|
|
