|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 59651-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 64980-281-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 64980-281-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: InnovAge PACE Commercial |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other HMO |
$0.15
|
| Rate for Payer: United Healthcare HMO Rider |
$0.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Vantage Medical Group Senior |
$0.26
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 59651-270-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.23
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Central Health Plan Commercial |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Senior |
$0.12
|
| Rate for Payer: Galaxy Health WC |
$0.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: Networks By Design Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.26
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 59651-268-30
|
| 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 |
$0.14
|
| 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: 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: InnovAge PACE Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 64980-279-03
|
| 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 |
$0.14
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 64980-279-03
|
| 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 |
$0.14
|
| 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: 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: InnovAge PACE Commercial |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.18
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 59651-268-30
|
| 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 |
$0.14
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.29
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: InnovAge PACE Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.36
|
| Rate for Payer: United Healthcare All Other HMO |
$0.36
|
| Rate for Payer: United Healthcare HMO Rider |
$0.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.58
|
| Rate for Payer: Cigna of CA HMO |
$0.50
|
| Rate for Payer: Cigna of CA PPO |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Senior |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Networks By Design Commercial |
$0.47
|
| Rate for Payer: Prime Health Services Commercial |
$0.61
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
|
IP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$272.90 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$234.39
|
| Rate for Payer: Blue Shield of California EPN |
$152.82
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Central Health Plan Commercial |
$242.58
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.29
|
| Rate for Payer: EPIC Health Plan Senior |
$121.29
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.64
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
|
OP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$377.35 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$195.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.81
|
| Rate for Payer: Blue Shield of California Commercial |
$226.51
|
| Rate for Payer: Blue Shield of California EPN |
$205.92
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Central Health Plan Commercial |
$242.58
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.32
|
| Rate for Payer: EPIC Health Plan Senior |
$195.79
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$321.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.79
|
| Rate for Payer: InnovAge PACE Commercial |
$293.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.36
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$195.79
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: Prime Health Services Medicare |
$207.54
|
| Rate for Payer: Riverside University Health System MISP |
$215.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$195.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.37
|
| Rate for Payer: Vantage Medical Group Senior |
$215.37
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$259.73
|
| Rate for Payer: Blue Shield of California EPN |
$169.34
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$377.35 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$195.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.81
|
| Rate for Payer: Blue Shield of California Commercial |
$226.51
|
| Rate for Payer: Blue Shield of California EPN |
$205.92
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.32
|
| Rate for Payer: EPIC Health Plan Senior |
$195.79
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$321.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.79
|
| Rate for Payer: InnovAge PACE Commercial |
$293.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.36
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$195.79
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Prime Health Services Medicare |
$207.54
|
| Rate for Payer: Riverside University Health System MISP |
$215.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.10
|
| Rate for Payer: United Healthcare All Other HMO |
$122.74
|
| Rate for Payer: United Healthcare HMO Rider |
$120.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$195.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.37
|
| Rate for Payer: Vantage Medical Group Senior |
$215.37
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
IP
|
$303.22
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$272.90 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$234.39
|
| Rate for Payer: Blue Shield of California EPN |
$152.82
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Central Health Plan Commercial |
$242.58
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.29
|
| Rate for Payer: EPIC Health Plan Senior |
$121.29
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.64
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
IP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$272.90 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Blue Shield of California Commercial |
$234.39
|
| Rate for Payer: Blue Shield of California EPN |
$152.82
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Central Health Plan Commercial |
$242.58
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.29
|
| Rate for Payer: EPIC Health Plan Senior |
$121.29
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.64
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
OP
|
$303.22
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$377.35 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$195.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.81
|
| Rate for Payer: Blue Shield of California Commercial |
$226.51
|
| Rate for Payer: Blue Shield of California EPN |
$205.92
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Central Health Plan Commercial |
$242.58
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.32
|
| Rate for Payer: EPIC Health Plan Senior |
$195.79
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$321.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.79
|
| Rate for Payer: InnovAge PACE Commercial |
$293.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.36
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$195.79
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: Prime Health Services Medicare |
$207.54
|
| Rate for Payer: Riverside University Health System MISP |
$215.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$195.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.37
|
| Rate for Payer: Vantage Medical Group Senior |
$215.37
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
OP
|
$303.22
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$480.39 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$144.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$480.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.43
|
| Rate for Payer: Blue Shield of California Commercial |
$279.98
|
| Rate for Payer: Blue Shield of California EPN |
$254.53
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Cash Price |
$166.77
|
| Rate for Payer: Central Health Plan Commercial |
$242.58
|
| Rate for Payer: Cigna of CA HMO |
$212.25
|
| Rate for Payer: Cigna of CA PPO |
$212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.59
|
| Rate for Payer: EPIC Health Plan Senior |
$144.88
|
| Rate for Payer: Galaxy Health WC |
$257.74
|
| Rate for Payer: Global Benefits Group Commercial |
$181.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.88
|
| Rate for Payer: InnovAge PACE Commercial |
$217.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.14
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: Networks By Design Commercial |
$151.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$144.88
|
| Rate for Payer: Prime Health Services Commercial |
$257.74
|
| Rate for Payer: Prime Health Services Medicare |
$153.57
|
| Rate for Payer: Riverside University Health System MISP |
$159.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.80
|
| Rate for Payer: United Healthcare All Other HMO |
$110.77
|
| Rate for Payer: United Healthcare HMO Rider |
$108.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.37
|
| Rate for Payer: Vantage Medical Group Senior |
$159.37
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [226952]
|
Facility
|
OP
|
$335.76
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$480.39 |
| Rate for Payer: Adventist Health Commercial |
$67.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$144.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$480.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.43
|
| Rate for Payer: Blue Shield of California Commercial |
$279.98
|
| Rate for Payer: Blue Shield of California EPN |
$254.53
|
| Rate for Payer: Cash Price |
$184.67
|
| Rate for Payer: Cash Price |
$184.67
|
| Rate for Payer: Central Health Plan Commercial |
$268.61
|
| Rate for Payer: Cigna of CA HMO |
$235.03
|
| Rate for Payer: Cigna of CA PPO |
$235.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$159.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.59
|
| Rate for Payer: EPIC Health Plan Senior |
$144.88
|
| Rate for Payer: Galaxy Health WC |
$285.40
|
| Rate for Payer: Global Benefits Group Commercial |
$201.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.88
|
| Rate for Payer: InnovAge PACE Commercial |
$217.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.14
|
| Rate for Payer: Multiplan Commercial |
$251.82
|
| Rate for Payer: Networks By Design Commercial |
$167.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$144.88
|
| Rate for Payer: Prime Health Services Commercial |
$285.40
|
| Rate for Payer: Prime Health Services Medicare |
$153.57
|
| Rate for Payer: Riverside University Health System MISP |
$159.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.01
|
| Rate for Payer: United Healthcare All Other HMO |
$122.65
|
| Rate for Payer: United Healthcare HMO Rider |
$120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.37
|
| Rate for Payer: Vantage Medical Group Senior |
$159.37
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [226952]
|
Facility
|
IP
|
$335.76
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$302.18 |
| Rate for Payer: Adventist Health Commercial |
$67.15
|
| Rate for Payer: Blue Shield of California Commercial |
$259.54
|
| Rate for Payer: Blue Shield of California EPN |
$169.22
|
| Rate for Payer: Cash Price |
$184.67
|
| Rate for Payer: Central Health Plan Commercial |
$268.61
|
| Rate for Payer: Cigna of CA HMO |
$235.03
|
| Rate for Payer: Cigna of CA PPO |
$235.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.30
|
| Rate for Payer: EPIC Health Plan Senior |
$134.30
|
| Rate for Payer: Galaxy Health WC |
$285.40
|
| Rate for Payer: Global Benefits Group Commercial |
$201.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$251.82
|
| Rate for Payer: Networks By Design Commercial |
$167.88
|
| Rate for Payer: Prime Health Services Commercial |
$285.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.01
|
| Rate for Payer: United Healthcare All Other HMO |
$122.65
|
| Rate for Payer: United Healthcare HMO Rider |
$120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.96
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET [16050]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 8770142600
|
| 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 |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.07
|
| 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: 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: InnovAge PACE Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.08
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET [16050]
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 8770142600
|
| 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 |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Central Health Plan Commercial |
$0.10
|
| Rate for Payer: Cigna of CA HMO |
$0.08
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA 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
|
|
|
GLUCOSE 50% FOR TPN [408002365]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 0338-9787-04
|
| Hospital Charge Code |
901700004
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
