|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 59651-268-30
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| 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 |
$0.14
|
| 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 Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| 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 Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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
|
| 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 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
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 64980-279-03
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| 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 |
$0.14
|
| 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 Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| 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 Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| 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
|
| 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 Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 64980-279-03
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| 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: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: 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: 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
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 59651-268-30
|
| Hospital Charge Code |
1711811
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Blue Shield of California Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| 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: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: 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: 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 |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| 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 |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: Blue Distinction Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| 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 Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| 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
|
| 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 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 68084-111-11
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| 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: 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: 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 68084-111-01
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California EPN |
$0.38
|
| Rate for Payer: Cash Price |
$0.32
|
| 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: 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: 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
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68084-111-11
|
| Hospital Charge Code |
1711632
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| 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 |
$0.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.43
|
| Rate for Payer: Blue Distinction Transplant |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| 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 Media |
$0.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.29
|
| Rate for Payer: Galaxy Health WC |
$0.61
|
| Rate for Payer: Global Benefits Group Commercial |
$0.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| 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
|
| 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 Medi-Cal |
$0.61
|
| Rate for Payer: Vantage Medical Group Senior |
$0.61
|
|
|
Glossectomy; less than one-half tongue
|
Facility
|
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 41120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,072.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: InnovAge PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health System MISP |
$8,048.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
Glossectomy; partial, with unilateral radical neck dissection
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 41135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,083.20 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,501.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,083.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
|
IP
|
$265.98
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
1720502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.38 |
| Rate for Payer: Blue Shield of California Commercial |
$199.48
|
| Rate for Payer: Blue Shield of California EPN |
$142.03
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Central Health Plan Commercial |
$212.78
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.39
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$199.48
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.43
|
| Rate for Payer: United Healthcare All Other HMO |
$98.09
|
| Rate for Payer: United Healthcare HMO Rider |
$95.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
GLUCAGON 1 MG INJ SOLUTION. [408121354]
|
Facility
|
OP
|
$265.98
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
1720502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$1,167.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$188.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,167.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.08
|
| Rate for Payer: Blue Distinction Transplant |
$159.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.32
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| Rate for Payer: Caremore Medicare Advantage |
$188.37
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Central Health Plan Commercial |
$212.78
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.55
|
| Rate for Payer: Dignity Health Media |
$188.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.37
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$199.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$308.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$310.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.37
|
| Rate for Payer: InnovAge PACE Commercial |
$282.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.41
|
| Rate for Payer: Multiplan Commercial |
$199.48
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
| Rate for Payer: Prime Health Services Medicare |
$199.67
|
| Rate for Payer: Riverside University Health System MISP |
$207.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.99
|
| Rate for Payer: United Healthcare All Other HMO |
$132.99
|
| Rate for Payer: United Healthcare HMO Rider |
$132.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Vantage Medical Group Senior |
$188.37
|
|
|
GLUCAGON 1 MG/ML SOLUTION FOR INJECTION [121354]
|
Facility
|
IP
|
$205.92
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
ERX121354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.18 |
| Max. Negotiated Rate |
$185.33 |
| Rate for Payer: Blue Shield of California Commercial |
$154.44
|
| Rate for Payer: Blue Shield of California EPN |
$109.96
|
| Rate for Payer: Cash Price |
$92.66
|
| Rate for Payer: Central Health Plan Commercial |
$164.74
|
| Rate for Payer: Cigna of CA HMO |
$144.14
|
| Rate for Payer: Cigna of CA PPO |
$144.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$82.37
|
| Rate for Payer: Galaxy Health WC |
$175.03
|
| Rate for Payer: Global Benefits Group Commercial |
$123.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.18
|
| Rate for Payer: Multiplan Commercial |
$154.44
|
| Rate for Payer: Networks By Design Commercial |
$102.96
|
| Rate for Payer: Prime Health Services Commercial |
$175.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Other HMO |
$75.94
|
| Rate for Payer: United Healthcare HMO Rider |
$74.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.95
|
|
|
GLUCAGON 1 MG/ML SOLUTION FOR INJECTION [121354]
|
Facility
|
OP
|
$205.92
|
|
|
Service Code
|
CPT J1610
|
| Hospital Charge Code |
ERX121354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.18 |
| Max. Negotiated Rate |
$1,167.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$188.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,167.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.08
|
| Rate for Payer: Blue Distinction Transplant |
$123.55
|
| Rate for Payer: Blue Shield of California Commercial |
$221.32
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| Rate for Payer: Caremore Medicare Advantage |
$188.37
|
| Rate for Payer: Cash Price |
$92.66
|
| Rate for Payer: Cash Price |
$92.66
|
| Rate for Payer: Central Health Plan Commercial |
$164.74
|
| Rate for Payer: Cigna of CA HMO |
$144.14
|
| Rate for Payer: Cigna of CA PPO |
$144.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.55
|
| Rate for Payer: Dignity Health Media |
$188.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.37
|
| Rate for Payer: Galaxy Health WC |
$175.03
|
| Rate for Payer: Global Benefits Group Commercial |
$123.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$154.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$308.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$310.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.37
|
| Rate for Payer: InnovAge PACE Commercial |
$282.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.41
|
| Rate for Payer: Multiplan Commercial |
$154.44
|
| Rate for Payer: Networks By Design Commercial |
$102.96
|
| Rate for Payer: Prime Health Services Commercial |
$175.03
|
| Rate for Payer: Prime Health Services Medicare |
$199.67
|
| Rate for Payer: Riverside University Health System MISP |
$207.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.96
|
| Rate for Payer: United Healthcare All Other HMO |
$102.96
|
| Rate for Payer: United Healthcare HMO Rider |
$102.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Vantage Medical Group Senior |
$188.37
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT J1610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$1,167.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$188.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,167.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.08
|
| Rate for Payer: Blue Distinction Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$221.32
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| Rate for Payer: Caremore Medicare Advantage |
$188.37
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| 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 |
$282.55
|
| Rate for Payer: Dignity Health Media |
$188.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$188.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.37
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$308.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$310.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.37
|
| Rate for Payer: InnovAge PACE Commercial |
$282.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.41
|
| 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: Prime Health Services Medicare |
$199.67
|
| Rate for Payer: Riverside University Health System MISP |
$207.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.20
|
| Rate for Payer: Vantage Medical Group Senior |
$188.37
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [111859]
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT J1610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$179.42
|
| Rate for Payer: Cash Price |
$151.20
|
| 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 Transplant |
$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: 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 |
$126.87
|
| Rate for Payer: United Healthcare All Other HMO |
$123.92
|
| Rate for Payer: United Healthcare HMO Rider |
$121.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.88
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
IP
|
$265.98
|
|
|
Service Code
|
CPT J1611
|
| Hospital Charge Code |
ERX209701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.38 |
| Rate for Payer: Blue Shield of California Commercial |
$199.48
|
| Rate for Payer: Blue Shield of California EPN |
$142.03
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Central Health Plan Commercial |
$212.78
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.39
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$199.48
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.43
|
| Rate for Payer: United Healthcare All Other HMO |
$98.09
|
| Rate for Payer: United Healthcare HMO Rider |
$95.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.77
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [209701]
|
Facility
|
OP
|
$265.98
|
|
|
Service Code
|
CPT J1611
|
| Hospital Charge Code |
ERX209701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$767.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$123.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.25
|
| Rate for Payer: Blue Distinction Transplant |
$159.59
|
| Rate for Payer: Blue Shield of California Commercial |
$167.30
|
| Rate for Payer: Blue Shield of California EPN |
$130.06
|
| Rate for Payer: Caremore Medicare Advantage |
$123.83
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Cash Price |
$119.69
|
| Rate for Payer: Central Health Plan Commercial |
$212.78
|
| Rate for Payer: Cigna of CA HMO |
$186.19
|
| Rate for Payer: Cigna of CA PPO |
$186.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.74
|
| Rate for Payer: Dignity Health Media |
$123.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$123.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.83
|
| Rate for Payer: Galaxy Health WC |
$226.08
|
| Rate for Payer: Global Benefits Group Commercial |
$159.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$199.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$203.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.83
|
| Rate for Payer: InnovAge PACE Commercial |
$185.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.93
|
| Rate for Payer: Multiplan Commercial |
$199.48
|
| Rate for Payer: Networks By Design Commercial |
$132.99
|
| Rate for Payer: Prime Health Services Commercial |
$226.08
|
| Rate for Payer: Prime Health Services Medicare |
$131.26
|
| Rate for Payer: Riverside University Health System MISP |
$136.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.99
|
| Rate for Payer: United Healthcare All Other HMO |
$132.99
|
| Rate for Payer: United Healthcare HMO Rider |
$132.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.21
|
| Rate for Payer: Vantage Medical Group Senior |
$123.83
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET [16050]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 8770142600
|
| Hospital Charge Code |
ERX16050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.07
|
| 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 Distinction Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| 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: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Media |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$0.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.04
|
| 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: 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
|
| 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 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 |
ERX16050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.11 |
| 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 |
$0.05
|
| 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: EPIC Health Plan Commercial |
$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: 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 ORAL GEL. [40827466]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 574006915
|
| Hospital Charge Code |
1772070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| 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 |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 574006930
|
| Hospital Charge Code |
1772070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| 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 |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 574006945
|
| Hospital Charge Code |
NDG27466B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| 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 |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 574006915
|
| Hospital Charge Code |
1772070
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
GLUCOSE ORAL GEL. [40827466]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 574006945
|
| Hospital Charge Code |
NDG27466B
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.06
|
| Rate for Payer: Blue Distinction Transplant |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Central Health Plan Commercial |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Riverside University Health System MISP |
$0.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Other HMO |
$0.05
|
| Rate for Payer: United Healthcare HMO Rider |
$0.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
