|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 6068716111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 0378032701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.49
|
| Rate for Payer: United Healthcare All Other HMO |
$0.49
|
| Rate for Payer: United Healthcare HMO Rider |
$0.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Vantage Medical Group Senior |
$0.83
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 5107973601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 5107973620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 5107973620
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 5107973601
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
NDC 0378032701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna of CA HMO |
$0.69
|
| Rate for Payer: Cigna of CA PPO |
$0.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Senior |
$0.39
|
| Rate for Payer: Galaxy Health WC |
$0.83
|
| Rate for Payer: Global Benefits Group Commercial |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.78
|
| Rate for Payer: Networks By Design Commercial |
$0.64
|
| Rate for Payer: Prime Health Services Commercial |
$0.83
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 6068716111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.70
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO |
$0.76
|
| Rate for Payer: Cigna of CA PPO |
$0.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Senior |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$0.87
|
| Rate for Payer: Networks By Design Commercial |
$0.71
|
| Rate for Payer: Prime Health Services Commercial |
$0.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.55
|
| Rate for Payer: United Healthcare All Other HMO |
$0.55
|
| Rate for Payer: United Healthcare HMO Rider |
$0.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
IP
|
$52.80
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$44.88 |
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California Commercial |
$38.76
|
| Rate for Payer: Blue Shield of California Commercial |
$26.77
|
| Rate for Payer: Blue Shield of California Commercial |
$40.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.55
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cigna of CA HMO |
$36.96
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$36.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.12
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$44.88
|
| Rate for Payer: Global Benefits Group Commercial |
$31.68
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.67
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$42.24
|
| Rate for Payer: Networks By Design Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Prime Health Services Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.82
|
| Rate for Payer: United Healthcare All Other HMO |
$19.29
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.29
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.83
|
| Rate for Payer: Blue Shield of California Commercial |
$25.77
|
| Rate for Payer: Blue Shield of California Commercial |
$25.77
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cigna of CA HMO |
$36.96
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$36.96
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.12
|
| Rate for Payer: EPIC Health Plan Senior |
$21.12
|
| Rate for Payer: EPIC Health Plan Senior |
$20.16
|
| Rate for Payer: Galaxy Health WC |
$44.88
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Global Benefits Group Commercial |
$31.68
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.96
|
| Rate for Payer: Multiplan Commercial |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Networks By Design Commercial |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$44.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.82
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$19.29
|
| Rate for Payer: United Healthcare HMO Rider |
$18.87
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.88
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$44.88
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
IP
|
$33.70
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$17.09
|
| Rate for Payer: Blue Shield of California Commercial |
$25.92
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cigna of CA HMO |
$23.59
|
| Rate for Payer: Cigna of CA PPO |
$23.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$26.96
|
| Rate for Payer: Networks By Design Commercial |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.65
|
| Rate for Payer: United Healthcare All Other HMO |
$12.31
|
| Rate for Payer: United Healthcare HMO Rider |
$12.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
OP
|
$33.70
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.83
|
| Rate for Payer: Blue Shield of California Commercial |
$25.77
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cash Price |
$15.16
|
| Rate for Payer: Cigna of CA HMO |
$23.59
|
| Rate for Payer: Cigna of CA PPO |
$23.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.59
|
| Rate for Payer: Multiplan Commercial |
$26.96
|
| Rate for Payer: Networks By Design Commercial |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.65
|
| Rate for Payer: United Healthcare All Other HMO |
$12.31
|
| Rate for Payer: United Healthcare HMO Rider |
$12.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Vantage Medical Group Senior |
$28.64
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.77
|
| Rate for Payer: EPIC Health Plan Senior |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.75
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$18,177.57
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$14,518.13 |
| Max. Negotiated Rate |
$18,177.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,518.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,177.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,264.14
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$82,858.24
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$66,177.57 |
| Max. Negotiated Rate |
$82,858.24 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66,177.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82,858.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74,136.32
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$24,611.08
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$19,656.48 |
| Max. Negotiated Rate |
$24,611.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,656.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,611.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,020.44
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$37,763.64
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$30,161.22 |
| Max. Negotiated Rate |
$37,763.64 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,161.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,763.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,788.52
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$107,185.30
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$107,185.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,726.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$107,185.30
|
| Rate for Payer: EPIC Health Plan Senior |
$71,456.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64,960.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90,945.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,047.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$97,390.14
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$97,390.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,992.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,390.14
|
| Rate for Payer: EPIC Health Plan Senior |
$64,926.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,024.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,634.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,092.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$114,105.78
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$114,105.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,428.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$114,105.78
|
| Rate for Payer: EPIC Health Plan Senior |
$76,070.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$69,155.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,817.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92,667.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HB COVID-19 RNA
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$372.39 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Blue Shield of California Commercial |
$105.94
|
| Rate for Payer: Blue Shield of California Commercial |
$61.77
|
| Rate for Payer: Blue Shield of California Commercial |
$70.07
|
| Rate for Payer: Blue Shield of California Commercial |
$93.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HB COVID-19 RNA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$305.54 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.54
|
| Rate for Payer: Blue Shield of California Commercial |
$110.13
|
| Rate for Payer: Blue Shield of California Commercial |
$55.32
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California Commercial |
$83.64
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: EPIC Health Plan Senior |
$32.56
|
| Rate for Payer: EPIC Health Plan Senior |
$32.56
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$134.30 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Senior |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
