|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 6050501410
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 5026836115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.22
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.23
|
| Rate for Payer: Heritage Provider Network Senior |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
|
|
GLIPIZIDE 5 MG TABLET [10117]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 5026836115
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.21
|
| Rate for Payer: Heritage Provider Network Senior |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.29
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 6498028101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 6498028101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
GLIPIZIDE ER 10 MG TABLET, EXTENDED RELEASE 24 HR [37650]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 5965127001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| 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 HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.20
|
| 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 |
$0.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.19
|
| Rate for Payer: Heritage Provider Network Senior |
$0.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.12
|
| Rate for Payer: TriValley Medical Group Senior |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 5965127001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.19
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.20
|
| Rate for Payer: Heritage Provider Network Senior |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.23
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 6498027903
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.06
|
| Rate for Payer: TriValley Medical Group Senior |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.12
|
| Rate for Payer: Vantage Medical Group Senior |
$0.12
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 5965126830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 HMO/PPO |
$0.13
|
| 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: Cigna of CA HMO/PPO |
$0.17
|
| 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 |
$0.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 5965126830
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 6498027903
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Senior |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 6808411101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| 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 |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 6808411111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$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 HMO/PPO |
$0.36
|
| Rate for Payer: Blue Shield of California Commercial |
$0.44
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| 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 |
$0.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 6808411111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 6808411101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
|
|
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
|
Facility
|
OP
|
$14,466.39
|
|
|
Service Code
|
CPT 41120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$14,466.39 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,365.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,466.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,375.28
|
| Rate for Payer: TriValley Medical Group Senior |
$8,375.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
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 |
$54.88 |
| Max. Negotiated Rate |
$227.41 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.42
|
| Rate for Payer: Blue Shield of California Commercial |
$175.03
|
| Rate for Payer: Blue Shield of California EPN |
$175.03
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$117.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.39
|
| Rate for Payer: Heritage Provider Network Senior |
$140.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.22
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$121.29
|
| Rate for Payer: TriValley Medical Group Senior |
$121.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Vantage Medical Group Senior |
$129.06
|
|
|
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 |
$54.88 |
| Max. Negotiated Rate |
$227.41 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.27
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.39
|
| Rate for Payer: Heritage Provider Network Senior |
$140.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.81
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.40
|
|
|
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 |
$60.82 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.38
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$154.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.57
|
| Rate for Payer: Heritage Provider Network Senior |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$121.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$111.25
|
|
|
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 |
$60.82 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.42
|
| Rate for Payer: Blue Shield of California Commercial |
$175.03
|
| Rate for Payer: Blue Shield of California EPN |
$175.03
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$154.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$117.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.57
|
| Rate for Payer: Heritage Provider Network Senior |
$155.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$160.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.22
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$121.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$111.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Vantage Medical Group Senior |
$129.06
|
|
|
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 |
$54.88 |
| Max. Negotiated Rate |
$227.41 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.42
|
| Rate for Payer: Blue Shield of California Commercial |
$175.03
|
| Rate for Payer: Blue Shield of California EPN |
$175.03
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$117.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.39
|
| Rate for Payer: Heritage Provider Network Senior |
$140.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.22
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$121.29
|
| Rate for Payer: TriValley Medical Group Senior |
$121.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.06
|
| Rate for Payer: Vantage Medical Group Senior |
$129.06
|
|
|
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 |
$54.88 |
| Max. Negotiated Rate |
$227.41 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.27
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.39
|
| Rate for Payer: Heritage Provider Network Senior |
$140.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.81
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.40
|
|
|
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 |
$54.88 |
| Max. Negotiated Rate |
$403.02 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.02
|
| Rate for Payer: Blue Shield of California Commercial |
$216.35
|
| Rate for Payer: Blue Shield of California EPN |
$216.35
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$129.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.39
|
| Rate for Payer: Heritage Provider Network Senior |
$140.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$144.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$173.24
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$121.29
|
| Rate for Payer: TriValley Medical Group Senior |
$121.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Vantage Medical Group Senior |
$142.21
|
|
|
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 |
$54.88 |
| Max. Negotiated Rate |
$227.41 |
| Rate for Payer: Adventist Health Commercial |
$60.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$195.27
|
| Rate for Payer: Cash Price |
$136.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.39
|
| Rate for Payer: Heritage Provider Network Senior |
$140.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.81
|
| Rate for Payer: Multiplan Commercial |
$227.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.40
|
|
|
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 |
$60.77 |
| Max. Negotiated Rate |
$403.02 |
| Rate for Payer: Adventist Health Commercial |
$67.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.02
|
| Rate for Payer: Blue Shield of California Commercial |
$216.35
|
| Rate for Payer: Blue Shield of California EPN |
$216.35
|
| Rate for Payer: Cash Price |
$151.09
|
| Rate for Payer: Cash Price |
$151.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$154.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$161.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$129.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.46
|
| Rate for Payer: Heritage Provider Network Senior |
$155.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$129.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$160.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$173.24
|
| Rate for Payer: Multiplan Commercial |
$251.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.30
|
| Rate for Payer: TriValley Medical Group Senior |
$134.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$121.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$111.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$161.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.21
|
| Rate for Payer: Vantage Medical Group Senior |
$142.21
|
|
