|
GLYCERIN (ADULT) RECTAL SUPPOSITORY [15053]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0132007912
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY [15053]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0132007924
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY [15053]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 8770142510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY [15053]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 8770142510
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY [15053]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0132007912
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY [15053]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0132007924
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Senior |
$0.05
|
| Rate for Payer: Galaxy Health WC |
$0.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.08
|
| Rate for Payer: Prime Health Services Commercial |
$0.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY [3492]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 8770142512
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY [3492]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 8770142512
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
GLYCERIN (LAXATIVE) 2.8 GRAM/2.7 ML RECTAL SOLUTION [120948]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0132019012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.18
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
GLYCERIN (LAXATIVE) 2.8 GRAM/2.7 ML RECTAL SOLUTION [120948]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0132019012
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| 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 |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| 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 |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [3497]
|
Facility
|
OP
|
$1.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California Commercial |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$5.51
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$1.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Central Health Plan Commercial |
$0.67
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$2.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Central Health Plan Commercial |
$1.46
|
| Rate for Payer: Central Health Plan Commercial |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$2.01
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$2.25
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$4.22
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Galaxy Health WC |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.61
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: Riverside University Health System MISP |
$1.15
|
| Rate for Payer: Riverside University Health System MISP |
$1.29
|
| Rate for Payer: Riverside University Health System MISP |
$4.22
|
| Rate for Payer: Riverside University Health System MISP |
$1.25
|
| Rate for Payer: Riverside University Health System MISP |
$1.34
|
| Rate for Payer: Riverside University Health System MISP |
$0.34
|
| Rate for Payer: Riverside University Health System MISP |
$1.30
|
| Rate for Payer: Riverside University Health System MISP |
$0.96
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| Rate for Payer: Riverside University Health System MISP |
$0.73
|
| Rate for Payer: Riverside University Health System MISP |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.96
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare All Other HMO |
$3.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$3.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.71
|
| Rate for Payer: Vantage Medical Group Senior |
$2.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2.74
|
| Rate for Payer: Vantage Medical Group Senior |
$2.86
|
| Rate for Payer: Vantage Medical Group Senior |
$2.04
|
| Rate for Payer: Vantage Medical Group Senior |
$8.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2.44
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION [3497]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Adventist Health Commercial |
$0.29
|
| Rate for Payer: Adventist Health Commercial |
$0.65
|
| Rate for Payer: Adventist Health Commercial |
$2.11
|
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.17
|
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California Commercial |
$8.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Blue Shield of California EPN |
$1.69
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$1.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.46
|
| Rate for Payer: Central Health Plan Commercial |
$11.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.67
|
| Rate for Payer: Central Health Plan Commercial |
$8.45
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Central Health Plan Commercial |
$2.59
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.15
|
| Rate for Payer: Central Health Plan Commercial |
$2.69
|
| Rate for Payer: Cigna of CA HMO |
$2.01
|
| Rate for Payer: Cigna of CA HMO |
$2.35
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA HMO |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$7.39
|
| Rate for Payer: Cigna of CA HMO |
$1.27
|
| Rate for Payer: Cigna of CA HMO |
$2.27
|
| Rate for Payer: Cigna of CA HMO |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$1.01
|
| Rate for Payer: Cigna of CA PPO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$7.39
|
| Rate for Payer: Cigna of CA PPO |
$0.59
|
| Rate for Payer: Cigna of CA PPO |
$2.35
|
| Rate for Payer: Cigna of CA PPO |
$2.27
|
| Rate for Payer: Cigna of CA PPO |
$2.25
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$0.73
|
| Rate for Payer: EPIC Health Plan Senior |
$5.52
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.34
|
| Rate for Payer: EPIC Health Plan Senior |
$4.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.58
|
| Rate for Payer: EPIC Health Plan Senior |
$1.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1.30
|
| Rate for Payer: Galaxy Health WC |
$11.73
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$1.55
|
| Rate for Payer: Galaxy Health WC |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Galaxy Health WC |
$2.75
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Galaxy Health WC |
$2.74
|
| Rate for Payer: Galaxy Health WC |
$8.98
|
| Rate for Payer: Galaxy Health WC |
$2.86
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Global Benefits Group Commercial |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$8.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.50
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Global Benefits Group Commercial |
$1.09
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.93
|
| Rate for Payer: Global Benefits Group Commercial |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$10.35
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$2.42
|
| Rate for Payer: Networks By Design Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.91
|
| Rate for Payer: Networks By Design Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Networks By Design Commercial |
$1.61
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Networks By Design Commercial |
$6.90
|
| Rate for Payer: Networks By Design Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$1.62
|
| Rate for Payer: Networks By Design Commercial |
$1.68
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Prime Health Services Commercial |
$2.74
|
| Rate for Payer: Prime Health Services Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.86
|
| Rate for Payer: Prime Health Services Commercial |
$8.98
|
| Rate for Payer: Prime Health Services Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.93
|
| Rate for Payer: United Healthcare HMO Rider |
$3.77
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.30
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.10
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 2315560601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 1657174309
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 0904670961
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1.10
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 6931513901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.42
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 2315560601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Central Health Plan Commercial |
$0.11
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
| Rate for Payer: Riverside University Health System MISP |
$0.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 4988406501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.44
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.44
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 0904670961
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Adventist Health Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.66
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$0.91
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Senior |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.10
|
| Rate for Payer: Global Benefits Group Commercial |
$0.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.10
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 6931513901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.85
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.69
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 1657174309
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
GLYCOPYRROLATE 1 MG TABLET [10130]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 4988406501
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.42
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: Galaxy Health WC |
$0.44
|
| Rate for Payer: Global Benefits Group Commercial |
$0.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.44
|
| Rate for Payer: Riverside University Health System MISP |
$0.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other HMO |
$0.26
|
| Rate for Payer: United Healthcare HMO Rider |
$0.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.44
|
| Rate for Payer: Vantage Medical Group Senior |
$0.44
|
|
|
GLYCOPYRROLATE 2 MG TABLET [10131]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 2315560701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| 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 Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| 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
|
|
|
GLYCOPYRROLATE 2 MG TABLET [10131]
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 4988406601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Adventist Health Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Central Health Plan Commercial |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$0.65
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$0.79
|
| Rate for Payer: Global Benefits Group Commercial |
$0.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.70
|
| Rate for Payer: Networks By Design Commercial |
$0.60
|
| Rate for Payer: Prime Health Services Commercial |
$0.79
|
|
|
GLYCOPYRROLATE 2 MG TABLET [10131]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 5511164901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.71
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Central Health Plan Commercial |
$1.42
|
| Rate for Payer: Cigna of CA HMO |
$1.25
|
| Rate for Payer: Cigna of CA PPO |
$1.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.71
|
| Rate for Payer: EPIC Health Plan Senior |
$0.71
|
| Rate for Payer: Galaxy Health WC |
$1.51
|
| Rate for Payer: Global Benefits Group Commercial |
$1.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$1.33
|
| Rate for Payer: Networks By Design Commercial |
$1.16
|
| Rate for Payer: Prime Health Services Commercial |
$1.51
|
| Rate for Payer: Riverside University Health System MISP |
$0.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare HMO Rider |
$0.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.51
|
| Rate for Payer: Vantage Medical Group Senior |
$1.51
|
|
