|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California Commercial |
$440.61
|
| Rate for Payer: Blue Shield of California EPN |
$287.28
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
OP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$549.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.85
|
| Rate for Payer: Blue Shield of California Commercial |
$99.45
|
| Rate for Payer: Blue Shield of California EPN |
$90.41
|
| Rate for Payer: Cash Price |
$497.24
|
| Rate for Payer: Cash Price |
$497.24
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.82
|
| Rate for Payer: EPIC Health Plan Senior |
$25.05
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.05
|
| Rate for Payer: InnovAge PACE Commercial |
$37.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.57
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Prime Health Services Medicare |
$26.56
|
| Rate for Payer: Riverside University Health System MISP |
$27.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.30
|
| Rate for Payer: United Healthcare All Other HMO |
$330.26
|
| Rate for Payer: United Healthcare HMO Rider |
$323.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.56
|
| Rate for Payer: Vantage Medical Group Senior |
$27.56
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
|
IP
|
$904.07
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$813.66 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Blue Shield of California Commercial |
$698.85
|
| Rate for Payer: Blue Shield of California EPN |
$455.65
|
| Rate for Payer: Cash Price |
$497.24
|
| Rate for Payer: Central Health Plan Commercial |
$723.26
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Senior |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$678.05
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.30
|
| Rate for Payer: United Healthcare All Other HMO |
$330.26
|
| Rate for Payer: United Healthcare HMO Rider |
$323.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.08
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.03 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$569.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,565.85
|
| Rate for Payer: Cash Price |
$1,565.85
|
| Rate for Payer: Cash Price |
$1,565.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,277.60
|
| Rate for Payer: Cigna of CA HMO |
$1,822.08
|
| Rate for Payer: Cigna of CA PPO |
$2,106.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,419.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,708.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,562.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,898.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$2,135.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,850.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.95
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,708.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.40 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Adventist Health Commercial |
$569.40
|
| Rate for Payer: Cash Price |
$1,565.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,138.80
|
| Rate for Payer: Galaxy Health WC |
$2,419.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,708.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,562.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,898.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,084.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,762.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$2,135.25
|
| Rate for Payer: Networks By Design Commercial |
$1,850.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.95
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
IP
|
$2,998.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.60 |
| Max. Negotiated Rate |
$2,698.20 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,199.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,199.20
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,142.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,855.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,451.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,760.73
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Cash Price |
$1,648.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$785.56
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Prime Health Services Medicare |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [114723]
|
Facility
|
OP
|
$8.68
|
|
|
Service Code
|
NDC 0169-3685-12
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.46
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Central Health Plan Commercial |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.81
|
| Rate for Payer: InnovAge PACE Commercial |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.51
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
| Rate for Payer: Riverside University Health System MISP |
$3.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.38
|
| Rate for Payer: Vantage Medical Group Senior |
$7.38
|
|
|
INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [114723]
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
NDC 0169-3685-12
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Central Health Plan Commercial |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.51
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Central Health Plan Commercial |
$6.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.51
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
|
|
INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [28534]
|
Facility
|
OP
|
$8.68
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.46
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Central Health Plan Commercial |
$6.94
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.47
|
| Rate for Payer: EPIC Health Plan Senior |
$3.47
|
| Rate for Payer: Galaxy Health WC |
$7.38
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.81
|
| Rate for Payer: InnovAge PACE Commercial |
$4.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.51
|
| Rate for Payer: Networks By Design Commercial |
$5.64
|
| Rate for Payer: Prime Health Services Commercial |
$7.38
|
| Rate for Payer: Riverside University Health System MISP |
$3.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.38
|
| Rate for Payer: Vantage Medical Group Senior |
$7.38
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
OP
|
$40.67
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Central Health Plan Commercial |
$32.54
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.34
|
| Rate for Payer: InnovAge PACE Commercial |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$20.34
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Riverside University Health System MISP |
$16.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO |
$14.86
|
| Rate for Payer: United Healthcare HMO Rider |
$14.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
IP
|
$40.67
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Blue Shield of California Commercial |
$31.44
|
| Rate for Payer: Blue Shield of California EPN |
$20.50
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Central Health Plan Commercial |
$32.54
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$20.34
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.26
|
| Rate for Payer: United Healthcare All Other HMO |
$14.86
|
| Rate for Payer: United Healthcare HMO Rider |
$14.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.32
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
|
OP
|
$7.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$6.17
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$3.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.55
|
| Rate for Payer: Riverside University Health System MISP |
$3.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6.55
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
|
IP
|
$7.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$6.17
|
| Rate for Payer: Cigna of CA HMO |
$5.40
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Senior |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$3.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.53
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.90
|
| Rate for Payer: Blue Shield of California EPN |
$5.15
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Central Health Plan Commercial |
$8.18
|
| Rate for Payer: Cigna of CA HMO |
$7.15
|
| Rate for Payer: Cigna of CA PPO |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.09
|
| Rate for Payer: EPIC Health Plan Senior |
$4.09
|
| Rate for Payer: Galaxy Health WC |
$8.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.64
|
| Rate for Payer: Prime Health Services Commercial |
$8.69
|
|
|
INSULIN GLULISINE (APIDRA) 100 UNIT/ML BOLUS FROM PUMP [4081881]
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 0088-2500-33
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Adventist Health Commercial |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Central Health Plan Commercial |
$8.18
|
| Rate for Payer: Cigna of CA HMO |
$7.15
|
| Rate for Payer: Cigna of CA PPO |
$7.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.09
|
| Rate for Payer: EPIC Health Plan Senior |
$4.09
|
| Rate for Payer: Galaxy Health WC |
$8.69
|
| Rate for Payer: Global Benefits Group Commercial |
$6.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.64
|
| Rate for Payer: Prime Health Services Commercial |
$8.69
|
| Rate for Payer: Riverside University Health System MISP |
$4.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.11
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare HMO Rider |
$5.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.69
|
| Rate for Payer: Vantage Medical Group Senior |
$8.69
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [87889]
|
Facility
|
OP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.73
|
| Rate for Payer: Blue Shield of California Commercial |
$16.37
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Central Health Plan Commercial |
$21.43
|
| Rate for Payer: Cigna of CA HMO |
$17.15
|
| Rate for Payer: Cigna of CA PPO |
$19.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.11
|
| Rate for Payer: InnovAge PACE Commercial |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.09
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
| Rate for Payer: Riverside University Health System MISP |
$10.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.39
|
| Rate for Payer: United Healthcare All Other HMO |
$13.39
|
| Rate for Payer: United Healthcare HMO Rider |
$13.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.77
|
| Rate for Payer: Vantage Medical Group Senior |
$22.77
|
|
|
INSULIN GLULISINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [87889]
|
Facility
|
IP
|
$26.79
|
|
|
Service Code
|
NDC 0088-2500-34
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Central Health Plan Commercial |
$21.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$20.09
|
| Rate for Payer: Networks By Design Commercial |
$17.41
|
| Rate for Payer: Prime Health Services Commercial |
$22.77
|
|
|
INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Central Health Plan Commercial |
$4.28
|
| Rate for Payer: Cigna of CA HMO |
$3.42
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.34
|
| Rate for Payer: InnovAge PACE Commercial |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: Riverside University Health System MISP |
$2.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.55
|
|
|
INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP [10286]
|
Facility
|
IP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Central Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
|
|
INSULIN LISPRO VIAL (HUMALOG, ADMELOG) 100 UNIT/ML SUBCUTANEOUS [17405]
|
Facility
|
IP
|
$11.77
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Central Health Plan Commercial |
$9.42
|
| Rate for Payer: Central Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$8.83
|
| Rate for Payer: Networks By Design Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$13.34
|
|
|
INSULIN LISPRO VIAL (HUMALOG, ADMELOG) 100 UNIT/ML SUBCUTANEOUS [17405]
|
Facility
|
OP
|
$11.77
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$7.19
|
| Rate for Payer: Blue Shield of California Commercial |
$9.59
|
| Rate for Payer: Blue Shield of California EPN |
$4.70
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Central Health Plan Commercial |
$9.42
|
| Rate for Payer: Central Health Plan Commercial |
$12.55
|
| Rate for Payer: Cigna of CA HMO |
$7.53
|
| Rate for Payer: Cigna of CA HMO |
$10.04
|
| Rate for Payer: Cigna of CA PPO |
$11.61
|
| Rate for Payer: Cigna of CA PPO |
$8.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.71
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: Galaxy Health WC |
$13.34
|
| Rate for Payer: Galaxy Health WC |
$10.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$7.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.34
|
| Rate for Payer: InnovAge PACE Commercial |
$5.88
|
| Rate for Payer: InnovAge PACE Commercial |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$8.83
|
| Rate for Payer: Networks By Design Commercial |
$7.65
|
| Rate for Payer: Networks By Design Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$13.34
|
| Rate for Payer: Riverside University Health System MISP |
$6.28
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO |
$7.84
|
| Rate for Payer: United Healthcare HMO Rider |
$5.88
|
| Rate for Payer: United Healthcare HMO Rider |
$7.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13.34
|
| Rate for Payer: Vantage Medical Group Senior |
$10.00
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION [10284]
|
Facility
|
IP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Central Health Plan Commercial |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
|
|
INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION [10284]
|
Facility
|
OP
|
$5.35
|
|
|
Service Code
|
HCPCS J1815
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.27
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Central Health Plan Commercial |
$4.28
|
| Rate for Payer: Cigna of CA HMO |
$3.42
|
| Rate for Payer: Cigna of CA PPO |
$3.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.14
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$4.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.34
|
| Rate for Payer: InnovAge PACE Commercial |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.01
|
| Rate for Payer: Networks By Design Commercial |
$3.48
|
| Rate for Payer: Prime Health Services Commercial |
$4.55
|
| Rate for Payer: Riverside University Health System MISP |
$2.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4.55
|
|
