|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
OP
|
$0.06
|
|
|
Service Code
|
NDC 60505-0141-0
|
| Hospital Charge Code |
1711376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: BCBS Transplant Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 51079-810-01
|
| Hospital Charge Code |
1711376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
OP
|
$0.38
|
|
|
Service Code
|
NDC 51079-810-20
|
| Hospital Charge Code |
1711376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: BCBS Transplant Transplant |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.32
|
| Rate for Payer: Dignity Health Media |
$0.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.32
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
IP
|
$0.06
|
|
|
Service Code
|
NDC 60505-0141-0
|
| Hospital Charge Code |
1711376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
IP
|
$0.38
|
|
|
Service Code
|
NDC 51079-810-20
|
| Hospital Charge Code |
1711376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.32
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 64980-281-01
|
| Hospital Charge Code |
1710894
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 59651-270-01
|
| Hospital Charge Code |
1710894
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| 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 |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
OP
|
$0.30
|
|
|
Service Code
|
NDC 64980-281-01
|
| Hospital Charge Code |
1710894
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: BCBS Transplant Transplant |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California EPN |
$0.18
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Media |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| 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 |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
IP
|
$0.30
|
|
|
Service Code
|
NDC 59651-270-01
|
| Hospital Charge Code |
1710894
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 64980-279-03
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 64980-279-03
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
IP
|
$0.26
|
|
|
Service Code
|
NDC 59651-268-30
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
OP
|
$0.26
|
|
|
Service Code
|
NDC 59651-268-30
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: BCBS Transplant Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-11
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-11
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-01
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: BCBS Transplant Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
IP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-01
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.37
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.58
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
OP
|
$265.98
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
1720502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$1,184.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$235.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.65
|
| Rate for Payer: BCBS Transplant Transplant |
$159.59
|
| Rate for Payer: Blue Shield of California Commercial |
$196.03
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.55
|
| Rate for Payer: Dignity Health Media |
$188.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.37
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$199.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$308.92
|
| Rate for Payer: IEHP Medi-Cal |
$305.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$305.15
|
| Rate for Payer: IEHP Medicare Advantage |
$188.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.41
|
| Rate for Payer: Multiplan Commercial |
$212.78
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.99
|
| Rate for Payer: United Healthcare All Other HMO |
$132.99
|
| Rate for Payer: United Healthcare HMO Rider |
$132.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Vantage Medical Group Senior |
$188.37
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
IP
|
$265.98
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
1720502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$226.08 |
| Rate for Payer: Blue Shield of California Commercial |
$189.38
|
| Rate for Payer: Blue Shield of California EPN |
$136.18
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.39
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.78
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
|
|
GLUCAGON 1 MG/ML SOLUTION FOR INJECTION [121354]
|
Facility
OP
|
$205.92
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
ERX121354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$1,184.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$235.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.65
|
| Rate for Payer: BCBS Transplant Transplant |
$123.55
|
| Rate for Payer: Blue Shield of California Commercial |
$151.76
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| Rate for Payer: Cash Price |
$92.66
|
| Rate for Payer: Cash Price |
$92.66
|
| Rate for Payer: Cigna of CA HMO |
$144.14
|
| Rate for Payer: Cigna of CA PPO |
$144.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.55
|
| Rate for Payer: Dignity Health Media |
$188.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.37
|
| Rate for Payer: Galaxy Health WC |
$175.03
|
| Rate for Payer: Global Benefits Group Commercial |
$123.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$154.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$308.92
|
| Rate for Payer: IEHP Medi-Cal |
$305.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$305.15
|
| Rate for Payer: IEHP Medicare Advantage |
$188.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.41
|
| Rate for Payer: Multiplan Commercial |
$164.74
|
| Rate for Payer: Networks By Design Commercial |
$102.96
|
| Rate for Payer: Prime Health Services Commercial |
$175.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.96
|
| Rate for Payer: United Healthcare All Other HMO |
$102.96
|
| Rate for Payer: United Healthcare HMO Rider |
$102.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Vantage Medical Group Senior |
$188.37
|
|
|
GLUCAGON 1 MG/ML SOLUTION FOR INJECTION [121354]
|
Facility
IP
|
$205.92
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
ERX121354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$175.03 |
| Rate for Payer: Blue Shield of California Commercial |
$146.62
|
| Rate for Payer: Blue Shield of California EPN |
$105.43
|
| Rate for Payer: Cash Price |
$92.66
|
| Rate for Payer: Cigna of CA HMO |
$144.14
|
| Rate for Payer: Cigna of CA PPO |
$144.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$82.37
|
| Rate for Payer: Galaxy Health WC |
$175.03
|
| Rate for Payer: Global Benefits Group Commercial |
$123.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.42
|
| Rate for Payer: Multiplan Commercial |
$164.74
|
| Rate for Payer: Networks By Design Commercial |
$102.96
|
| Rate for Payer: Prime Health Services Commercial |
$175.03
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
CPT J1610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Blue Shield of California Commercial |
$239.23
|
| Rate for Payer: Blue Shield of California EPN |
$172.03
|
| 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: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| 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
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT J1610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$1,184.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,184.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$235.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$207.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.65
|
| Rate for Payer: BCBS Transplant Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$247.63
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| 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 |
$282.55
|
| Rate for Payer: Dignity Health Media |
$188.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.37
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$308.92
|
| Rate for Payer: IEHP Medi-Cal |
$305.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$305.15
|
| Rate for Payer: IEHP Medicare Advantage |
$188.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.41
|
| 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 |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Vantage Medical Group Senior |
$188.37
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
OP
|
$265.98
|
|
|
Service Code
|
CPT J1611
|
| Hospital Charge Code |
ERX209701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$778.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$154.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$136.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.36
|
| Rate for Payer: BCBS Transplant Transplant |
$159.59
|
| Rate for Payer: Blue Shield of California Commercial |
$196.03
|
| Rate for Payer: Blue Shield of California EPN |
$155.33
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.74
|
| Rate for Payer: Dignity Health Media |
$123.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$123.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.83
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$199.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$203.08
|
| Rate for Payer: IEHP Medi-Cal |
$200.60
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$200.60
|
| Rate for Payer: IEHP Medicare Advantage |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.93
|
| Rate for Payer: Multiplan Commercial |
$212.78
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.99
|
| Rate for Payer: United Healthcare All Other HMO |
$132.99
|
| Rate for Payer: United Healthcare HMO Rider |
$132.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.21
|
| Rate for Payer: Vantage Medical Group Senior |
$123.83
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
IP
|
$265.98
|
|
|
Service Code
|
CPT J1611
|
| Hospital Charge Code |
ERX209701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$226.08 |
| Rate for Payer: Multiplan Commercial |
$212.78
|
| Rate for Payer: Blue Shield of California Commercial |
$189.38
|
| Rate for Payer: Blue Shield of California EPN |
$136.18
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.39
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
|
