|
HYDROXYZINE ORAL SOLUTION (IV FORM) 50 MG/ML [4080433]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 9994080433
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Central Health Plan Commercial |
$1.92
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.04
|
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [3777]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0555032302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
HYDROXYZINE PAMOATE 25 MG CAPSULE [3777]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0555032302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [17381]
|
Facility
|
IP
|
$273.92
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$246.53 |
| Rate for Payer: Adventist Health Commercial |
$54.78
|
| Rate for Payer: Blue Shield of California Commercial |
$219.68
|
| Rate for Payer: Blue Shield of California EPN |
$138.06
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Central Health Plan Commercial |
$219.14
|
| Rate for Payer: Cigna of CA HMO |
$191.74
|
| Rate for Payer: Cigna of CA PPO |
$191.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.57
|
| Rate for Payer: EPIC Health Plan Senior |
$109.57
|
| Rate for Payer: Galaxy Health WC |
$232.83
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.78
|
| Rate for Payer: Multiplan Commercial |
$205.44
|
| Rate for Payer: Networks By Design Commercial |
$136.96
|
| Rate for Payer: Prime Health Services Commercial |
$232.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.80
|
| Rate for Payer: United Healthcare All Other HMO |
$100.06
|
| Rate for Payer: United Healthcare HMO Rider |
$97.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.71
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE [17381]
|
Facility
|
OP
|
$273.92
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$246.53 |
| Rate for Payer: Adventist Health Commercial |
$54.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.18
|
| Rate for Payer: Blue Shield of California Commercial |
$37.66
|
| Rate for Payer: Blue Shield of California EPN |
$34.24
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Central Health Plan Commercial |
$219.14
|
| Rate for Payer: Cigna of CA HMO |
$191.74
|
| Rate for Payer: Cigna of CA PPO |
$191.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.93
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$232.83
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$205.44
|
| Rate for Payer: Networks By Design Commercial |
$136.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.02
|
| Rate for Payer: Prime Health Services Commercial |
$232.83
|
| Rate for Payer: Prime Health Services Medicare |
$6.38
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.80
|
| Rate for Payer: United Healthcare All Other HMO |
$100.06
|
| Rate for Payer: United Healthcare HMO Rider |
$97.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 5483851180
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
HYOSCYAMINE 0.125 MG/5 ML ORAL ELIXIR [3781]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 5483851180
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.06
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 4219233901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.31
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.22
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Other HMO |
$0.27
|
| Rate for Payer: United Healthcare HMO Rider |
$0.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET [17023]
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 4219233901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Central Health Plan Commercial |
$0.43
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.41
|
| Rate for Payer: Networks By Design Commercial |
$0.35
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
|
|
HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION [10239]
|
Facility
|
OP
|
$79.20
|
|
|
Service Code
|
HCPCS J1980
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$329.98 |
| Rate for Payer: Adventist Health Commercial |
$15.84
|
| Rate for Payer: Adventist Health Commercial |
$25.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Blue Shield of California Commercial |
$71.28
|
| Rate for Payer: Blue Shield of California Commercial |
$71.28
|
| Rate for Payer: Blue Shield of California EPN |
$64.80
|
| Rate for Payer: Blue Shield of California EPN |
$64.80
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Central Health Plan Commercial |
$103.68
|
| Rate for Payer: Central Health Plan Commercial |
$63.36
|
| Rate for Payer: Cigna of CA HMO |
$55.44
|
| Rate for Payer: Cigna of CA HMO |
$90.72
|
| Rate for Payer: Cigna of CA PPO |
$55.44
|
| Rate for Payer: Cigna of CA PPO |
$90.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.84
|
| Rate for Payer: EPIC Health Plan Senior |
$31.68
|
| Rate for Payer: Galaxy Health WC |
$110.16
|
| Rate for Payer: Galaxy Health WC |
$67.32
|
| Rate for Payer: Global Benefits Group Commercial |
$77.76
|
| Rate for Payer: Global Benefits Group Commercial |
$47.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$59.40
|
| Rate for Payer: Networks By Design Commercial |
$39.60
|
| Rate for Payer: Networks By Design Commercial |
$64.80
|
| Rate for Payer: Prime Health Services Commercial |
$67.32
|
| Rate for Payer: Prime Health Services Commercial |
$110.16
|
| Rate for Payer: Riverside University Health System MISP |
$51.84
|
| Rate for Payer: Riverside University Health System MISP |
$31.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.64
|
| Rate for Payer: United Healthcare All Other HMO |
$47.34
|
| Rate for Payer: United Healthcare All Other HMO |
$28.93
|
| Rate for Payer: United Healthcare HMO Rider |
$28.31
|
| Rate for Payer: United Healthcare HMO Rider |
$46.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.32
|
| Rate for Payer: Vantage Medical Group Senior |
$67.32
|
| Rate for Payer: Vantage Medical Group Senior |
$110.16
|
|
|
HYOSCYAMINE 0.5 MG/ML INJECTION SOLUTION [10239]
|
Facility
|
IP
|
$79.20
|
|
|
Service Code
|
HCPCS J1980
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Adventist Health Commercial |
$15.84
|
| Rate for Payer: Adventist Health Commercial |
$25.92
|
| Rate for Payer: Blue Shield of California Commercial |
$63.52
|
| Rate for Payer: Blue Shield of California Commercial |
$103.94
|
| Rate for Payer: Blue Shield of California EPN |
$65.32
|
| Rate for Payer: Blue Shield of California EPN |
$39.92
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Central Health Plan Commercial |
$63.36
|
| Rate for Payer: Central Health Plan Commercial |
$103.68
|
| Rate for Payer: Cigna of CA HMO |
$90.72
|
| Rate for Payer: Cigna of CA HMO |
$55.44
|
| Rate for Payer: Cigna of CA PPO |
$90.72
|
| Rate for Payer: Cigna of CA PPO |
$55.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.84
|
| Rate for Payer: EPIC Health Plan Senior |
$31.68
|
| Rate for Payer: Galaxy Health WC |
$67.32
|
| Rate for Payer: Galaxy Health WC |
$110.16
|
| Rate for Payer: Global Benefits Group Commercial |
$77.76
|
| Rate for Payer: Global Benefits Group Commercial |
$47.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Multiplan Commercial |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$59.40
|
| Rate for Payer: Networks By Design Commercial |
$64.80
|
| Rate for Payer: Networks By Design Commercial |
$39.60
|
| Rate for Payer: Prime Health Services Commercial |
$67.32
|
| Rate for Payer: Prime Health Services Commercial |
$110.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.72
|
| Rate for Payer: United Healthcare All Other HMO |
$28.93
|
| Rate for Payer: United Healthcare All Other HMO |
$47.34
|
| Rate for Payer: United Healthcare HMO Rider |
$46.32
|
| Rate for Payer: United Healthcare HMO Rider |
$28.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.94
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$14,598.84
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$9,220.32 |
| Max. Negotiated Rate |
$14,598.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,220.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,598.84
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$8,161.51
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$5,154.64 |
| Max. Negotiated Rate |
$8,161.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,154.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,142.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,161.51
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$10,099.15
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$6,378.41 |
| Max. Negotiated Rate |
$10,099.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,378.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,600.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,099.15
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$26,327.48
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$16,627.88 |
| Max. Negotiated Rate |
$26,327.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,627.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,814.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,327.48
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$31,319.61
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$31,319.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,319.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,231.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,324.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,568.30
|
| Rate for Payer: EPIC Health Plan Senior |
$19,045.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,314.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,239.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,200.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,314.12
|
| Rate for Payer: Prime Health Services Medicare |
$18,352.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$19,873.48
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$19,873.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,873.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,837.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,972.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,671.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12,447.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,315.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,842.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,163.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,315.97
|
| Rate for Payer: Prime Health Services Medicare |
$11,994.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$8,648.93
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$5,462.48 |
| Max. Negotiated Rate |
$8,648.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,462.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,509.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,648.93
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$6,056.67
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$3,825.26 |
| Max. Negotiated Rate |
$6,056.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,825.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,558.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,056.67
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$12,338.92
|
|
|
Service Code
|
APR-DRG 4223
|
| Min. Negotiated Rate |
$7,793.00 |
| Max. Negotiated Rate |
$12,338.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,793.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,286.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,338.92
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$19,154.94
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$12,097.86 |
| Max. Negotiated Rate |
$19,154.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,097.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,416.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,154.94
|
|
|
HYPROMELLOSE 2 % INTRAOCULAR SYRINGE [29834]
|
Facility
|
IP
|
$75.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Adventist Health Commercial |
$15.12
|
| Rate for Payer: Blue Shield of California Commercial |
$60.63
|
| Rate for Payer: Blue Shield of California EPN |
$38.10
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Central Health Plan Commercial |
$60.48
|
| Rate for Payer: Cigna of CA HMO |
$52.92
|
| Rate for Payer: Cigna of CA PPO |
$52.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.24
|
| Rate for Payer: EPIC Health Plan Senior |
$30.24
|
| Rate for Payer: Galaxy Health WC |
$64.26
|
| Rate for Payer: Global Benefits Group Commercial |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$56.70
|
| Rate for Payer: Networks By Design Commercial |
$37.80
|
| Rate for Payer: Prime Health Services Commercial |
$64.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.37
|
| Rate for Payer: United Healthcare All Other HMO |
$27.62
|
| Rate for Payer: United Healthcare HMO Rider |
$27.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.76
|
|
|
HYPROMELLOSE 2 % INTRAOCULAR SYRINGE [29834]
|
Facility
|
OP
|
$75.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Adventist Health Commercial |
$15.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.70
|
| Rate for Payer: Blue Shield of California Commercial |
$47.93
|
| Rate for Payer: Blue Shield of California EPN |
$30.16
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Central Health Plan Commercial |
$60.48
|
| Rate for Payer: Cigna of CA HMO |
$52.92
|
| Rate for Payer: Cigna of CA PPO |
$52.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.24
|
| Rate for Payer: EPIC Health Plan Senior |
$30.24
|
| Rate for Payer: Galaxy Health WC |
$64.26
|
| Rate for Payer: Global Benefits Group Commercial |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.92
|
| Rate for Payer: Multiplan Commercial |
$56.70
|
| Rate for Payer: Networks By Design Commercial |
$37.80
|
| Rate for Payer: Prime Health Services Commercial |
$64.26
|
| Rate for Payer: Riverside University Health System MISP |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.37
|
| Rate for Payer: United Healthcare All Other HMO |
$27.62
|
| Rate for Payer: United Healthcare HMO Rider |
$27.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.26
|
| Rate for Payer: Vantage Medical Group Senior |
$64.26
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 58558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$301.55 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$301.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE [70544]
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
