|
H35.3213
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3213
|
| Hospital Charge Code |
25
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3220
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3220
|
| Hospital Charge Code |
26
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3221
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3221
|
| Hospital Charge Code |
27
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3222
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3222
|
| Hospital Charge Code |
28
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3223
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3223
|
| Hospital Charge Code |
29
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3230
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3230
|
| Hospital Charge Code |
30
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3231
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3231
|
| Hospital Charge Code |
31
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3232
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3232
|
| Hospital Charge Code |
32
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3233
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3233
|
| Hospital Charge Code |
33
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3290
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3290
|
| Hospital Charge Code |
34
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3291
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3291
|
| Hospital Charge Code |
35
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3292
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3292
|
| Hospital Charge Code |
36
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.3293
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.3293
|
| Hospital Charge Code |
37
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
H35.359
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
ICD H35.359
|
| Hospital Charge Code |
38
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$3,000.00
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]
|
Facility
|
IP
|
$15.79
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.32
|
| Rate for Payer: EPIC Health Plan Senior |
$6.32
|
| Rate for Payer: Galaxy Health WC |
$13.42
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$12.63
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Commercial |
$13.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.93
|
| Rate for Payer: United Healthcare All Other HMO |
$5.77
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.17
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [11931]
|
Facility
|
OP
|
$15.79
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$97.68 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.15
|
| Rate for Payer: Blue Shield of California Commercial |
$14.46
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.32
|
| Rate for Payer: EPIC Health Plan Senior |
$6.32
|
| Rate for Payer: Galaxy Health WC |
$13.42
|
| Rate for Payer: Global Benefits Group Commercial |
$9.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.05
|
| Rate for Payer: Multiplan Commercial |
$12.63
|
| Rate for Payer: Networks By Design Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Commercial |
$13.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.93
|
| Rate for Payer: United Healthcare All Other HMO |
$5.77
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.42
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HALOPERIDOL 0.5 MG TABLET [3578]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 5107973301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
HALOPERIDOL 0.5 MG TABLET [3578]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 5107973320
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| 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 |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
HALOPERIDOL 0.5 MG TABLET [3578]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 5107973320
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
HALOPERIDOL 0.5 MG TABLET [3578]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 5107973301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| 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 |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
HALOPERIDOL 10 MG TABLET [3580]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 6808424911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
HALOPERIDOL 10 MG TABLET [3580]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 6808424911
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
|
|
HALOPERIDOL 10 MG TABLET [3580]
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 0832155011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California Commercial |
$0.60
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
|
|
HALOPERIDOL 10 MG TABLET [3580]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 6808424901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$1.09
|
| Rate for Payer: Cigna of CA PPO |
$1.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.25
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
HALOPERIDOL 10 MG TABLET [3580]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 0832155011
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.50
|
| Rate for Payer: Cash Price |
$0.35
|
| Rate for Payer: Cigna of CA HMO |
$0.55
|
| Rate for Payer: Cigna of CA PPO |
$0.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.31
|
| Rate for Payer: EPIC Health Plan Senior |
$0.31
|
| Rate for Payer: Galaxy Health WC |
$0.66
|
| Rate for Payer: Global Benefits Group Commercial |
$0.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$0.62
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Prime Health Services Commercial |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.66
|
| Rate for Payer: Vantage Medical Group Senior |
$0.66
|
|
