|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 51079-736-20
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| 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 |
$0.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.65
|
| Rate for Payer: Blue Distinction Transplant |
$0.65
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| 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 Media |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| 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
|
| 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 51079-736-20
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California EPN |
$0.56
|
| 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: EPIC Health Plan Commercial |
$0.44
|
| Rate for Payer: Galaxy Health WC |
$0.93
|
| Rate for Payer: Global Benefits Group Commercial |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.42
|
| 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 DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1722029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$64.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.17
|
| 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 |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.10
|
| Rate for Payer: Blue Distinction Transplant |
$30.24
|
| Rate for Payer: Blue Distinction Transplant |
$31.68
|
| Rate for Payer: Blue Shield of California Commercial |
$37.14
|
| Rate for Payer: Blue Shield of California Commercial |
$38.91
|
| Rate for Payer: Blue Shield of California EPN |
$26.65
|
| Rate for Payer: Blue Shield of California EPN |
$26.65
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$36.96
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: Cigna of CA PPO |
$36.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Media |
$44.88
|
| Rate for Payer: Dignity Health Media |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$39.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| 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: Multiplan Commercial |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$40.32
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$26.40
|
| Rate for Payer: Prime Health Services Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.40
|
| Rate for Payer: United Healthcare All Other HMO |
$26.40
|
| Rate for Payer: United Healthcare All Other HMO |
$25.20
|
| Rate for Payer: United Healthcare HMO Rider |
$26.40
|
| Rate for Payer: United Healthcare HMO Rider |
$25.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.88
|
| 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 |
$44.88
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1722029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Blue Shield of California Commercial |
$35.88
|
| Rate for Payer: Blue Shield of California Commercial |
$37.59
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Blue Shield of California EPN |
$27.03
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cigna of CA HMO |
$35.28
|
| Rate for Payer: Cigna of CA HMO |
$36.96
|
| Rate for Payer: Cigna of CA PPO |
$36.96
|
| Rate for Payer: Cigna of CA PPO |
$35.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.12
|
| 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 |
$25.20
|
| Rate for Payer: Networks By Design Commercial |
$26.40
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$44.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.94
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$19.47
|
| Rate for Payer: United Healthcare HMO Rider |
$18.18
|
| Rate for Payer: United Healthcare HMO Rider |
$19.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.42
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
IP
|
$33.70
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1720525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Blue Shield of California Commercial |
$23.99
|
| Rate for Payer: Blue Shield of California EPN |
$17.25
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cigna of CA HMO |
$23.59
|
| Rate for Payer: Cigna of CA PPO |
$23.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.84
|
| 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 |
$12.73
|
| Rate for Payer: United Healthcare All Other HMO |
$12.43
|
| Rate for Payer: United Healthcare HMO Rider |
$12.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
OP
|
$33.70
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1720525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$64.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.17
|
| 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 |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.10
|
| Rate for Payer: Blue Distinction Transplant |
$20.22
|
| Rate for Payer: Blue Shield of California Commercial |
$24.84
|
| Rate for Payer: Blue Shield of California EPN |
$26.65
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$15.17
|
| 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 Media |
$28.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| 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: 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 |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO |
$16.85
|
| Rate for Payer: United Healthcare HMO Rider |
$16.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.85
|
| 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
|
$1.06
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
1720105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| 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 |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.92
|
| Rate for Payer: Blue Distinction Transplant |
$4.31
|
| Rate for Payer: Blue Distinction Transplant |
$1.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5.30
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$0.48
|
| 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 |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| 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 |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Media |
$1.63
|
| Rate for Payer: Dignity Health Media |
$0.90
|
| Rate for Payer: Dignity Health Media |
$6.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| 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: Health Plan of Nevada (Sierra) Other |
$0.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| 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: 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 |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| 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 |
$0.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.11
|
| 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 Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
1720105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.54
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cash Price |
$3.24
|
| 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 |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| 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 Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| 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: 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: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| 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 |
$2.71
|
| 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 HMO |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$2.65
|
| Rate for Payer: United Healthcare HMO Rider |
$2.59
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.37
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$26,585.94
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$20,394.21 |
| Max. Negotiated Rate |
$26,585.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,394.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,585.94
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$12,760.04
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$9,788.29 |
| Max. Negotiated Rate |
$12,760.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,788.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,760.04
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$17,227.40
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$13,215.23 |
| Max. Negotiated Rate |
$17,227.40 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,215.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,227.40
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$48,498.81
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$37,203.69 |
| Max. Negotiated Rate |
$48,498.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,203.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,498.81
|
|
|
HB COVID-19 RNA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$329.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.96
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$329.17
|
| Rate for Payer: Blue Distinction Transplant |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$36.82
|
| Rate for Payer: Blue Shield of California EPN |
$29.18
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Media |
$51.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$83.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| 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 HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HB COVID-19 RNA
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$270.08 |
| 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 Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.08
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Media |
$29.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$47.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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 HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| 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 Senior |
$29.60
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$485.76 |
| Max. Negotiated Rate |
$1,720.40 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$1,720.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,214.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,196.18
|
| Rate for Payer: Blue Shield of California EPN |
$949.26
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Dignity Health Media |
$1,720.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,720.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,720.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,720.40
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,606.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,275.21
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Media |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,039.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
IP
|
$3,710.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$890.40 |
| Max. Negotiated Rate |
$3,153.50 |
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,484.00
|
| Rate for Payer: Galaxy Health WC |
$3,153.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,226.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,474.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.40
|
| Rate for Payer: Multiplan Commercial |
$2,968.00
|
| Rate for Payer: Networks By Design Commercial |
$2,411.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,153.50
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
OP
|
$3,710.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$249.09 |
| Max. Negotiated Rate |
$3,153.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,556.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,210.42
|
| Rate for Payer: Blue Distinction Transplant |
$2,226.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,192.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,739.99
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: Cigna of CA HMO |
$2,374.40
|
| Rate for Payer: Cigna of CA PPO |
$2,745.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,153.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,226.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,782.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,474.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,968.00
|
| Rate for Payer: Networks By Design Commercial |
$2,411.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,153.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,226.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,226.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC 5-HIAA BY HPLC
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
900910535
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.69
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Media |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
OP
|
$2,562.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,177.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,409.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,409.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.68
|
| Rate for Payer: Blue Distinction Transplant |
$1,537.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,514.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,201.58
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna of CA HMO |
$1,639.68
|
| Rate for Payer: Cigna of CA PPO |
$1,895.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,177.70
|
| Rate for Payer: Dignity Health Media |
$2,177.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,177.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,024.80
|
| Rate for Payer: Galaxy Health WC |
$2,177.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,537.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,921.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.88
|
| Rate for Payer: Multiplan Commercial |
$2,049.60
|
| Rate for Payer: Networks By Design Commercial |
$1,665.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,537.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,537.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,281.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,281.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,281.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,177.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,177.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,177.70
|
|
|
HC ABCESS CATH EXCHANGE
|
Facility
|
IP
|
$2,562.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
909001859
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$2,177.70 |
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.80
|
| Rate for Payer: Galaxy Health WC |
$2,177.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,537.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.88
|
| Rate for Payer: Multiplan Commercial |
$2,049.60
|
| Rate for Payer: Networks By Design Commercial |
$1,665.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.70
|
|
|
HC ABDOMEN KUB SUPINE
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
909001702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.44 |
| Max. Negotiated Rate |
$536.35 |
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.40
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.44
|
| Rate for Payer: Multiplan Commercial |
$504.80
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
|
