|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 51079-736-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Blue Shield of California Commercial |
$0.84
|
| Rate for Payer: Blue Shield of California EPN |
$0.55
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Central Health Plan Commercial |
$0.87
|
| 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: 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: Health Management Network EPO/PPO |
$0.98
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| 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
|
IP
|
$52.80
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$47.52 |
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California Commercial |
$38.96
|
| Rate for Payer: Blue Shield of California EPN |
$25.40
|
| Rate for Payer: Blue Shield of California EPN |
$26.61
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Central Health Plan Commercial |
$42.24
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| 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: 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: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$39.60
|
| 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: 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 |
$4.61 |
| Max. Negotiated Rate |
$46.03 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.61
|
| 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 Exchange |
$46.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$25.77
|
| Rate for Payer: Blue Shield of California EPN |
$25.77
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Central Health Plan Commercial |
$40.32
|
| Rate for Payer: Central Health Plan Commercial |
$42.24
|
| 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 |
$42.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$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 Senior |
$20.16
|
| Rate for Payer: EPIC Health Plan Senior |
$21.12
|
| 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: Health Management Network EPO/PPO |
$47.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.61
|
| Rate for Payer: InnovAge PACE Commercial |
$25.20
|
| Rate for Payer: InnovAge PACE Commercial |
$26.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| 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 |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$39.60
|
| 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: Riverside University Health System MISP |
$20.16
|
| Rate for Payer: Riverside University Health System MISP |
$21.12
|
| 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 |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.92
|
| 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 |
$18.01
|
| 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
|
| 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 |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$44.88
|
|
|
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 |
$4.61 |
| Max. Negotiated Rate |
$46.03 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.47
|
| 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 Exchange |
$46.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.13
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$25.77
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Central Health Plan Commercial |
$26.96
|
| 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: 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: Health Management Network EPO/PPO |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.61
|
| Rate for Payer: InnovAge PACE Commercial |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.74
|
| 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 |
$25.27
|
| Rate for Payer: Networks By Design Commercial |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.64
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| 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 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 |
$30.33 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$26.05
|
| Rate for Payer: Blue Shield of California EPN |
$16.98
|
| Rate for Payer: Cash Price |
$18.53
|
| Rate for Payer: Central Health Plan Commercial |
$26.96
|
| 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 Senior |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.33
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$25.27
|
| 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 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 |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.17
|
| 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 Exchange |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.02
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.96
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$5.75
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| 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 |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| 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 |
$1.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.11
|
| 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 |
$0.42
|
| Rate for Payer: EPIC Health Plan Senior |
$0.77
|
| 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 |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.78
|
| Rate for Payer: InnovAge PACE Commercial |
$3.60
|
| Rate for Payer: InnovAge PACE Commercial |
$0.96
|
| Rate for Payer: InnovAge PACE Commercial |
$0.53
|
| 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 |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.03
|
| 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 Medicare |
$0.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Riverside University Health System MISP |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| 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 |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| 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 |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO |
$0.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| 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
|
| 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 |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$7.19
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1.48
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Blue Shield of California EPN |
$3.62
|
| Rate for Payer: Blue Shield of California EPN |
$0.97
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$0.58
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$5.75
|
| 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 |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| 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 |
$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 |
$1.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| 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 Commercial |
$0.72
|
| 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 All Other HMO |
$2.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
|
|
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 |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| 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 Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$81.34
|
| Rate for Payer: Blue Shield of California EPN |
$53.20
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| 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 |
$26.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| 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: Upland Medical Group Pediatric |
$51.31
|
| 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 Senior |
$51.31
|
|
|
HB COVID-19 RNA
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
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 |
$215.35 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| 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 Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.71
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: InnovAge PACE Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| 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 |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Riverside University Health System MISP |
$32.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| 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: Upland Medical Group Pediatric |
$29.60
|
| 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 25 CH VITAMIN D2 D3
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
915350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$225.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.60
|
| Rate for Payer: Blue Shield of California Commercial |
$425.92
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: InnovAge PACE Commercial |
$275.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
915350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$425.92
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
905350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$425.92
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
|
|
HC 2-PIECE WITH THORACIC EXT.
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
905350174
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.45 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$225.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.60
|
| Rate for Payer: Blue Shield of California Commercial |
$425.92
|
| Rate for Payer: Blue Shield of California EPN |
$277.70
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Cash Price |
$303.05
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$385.70
|
| Rate for Payer: Cigna of CA PPO |
$385.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: InnovAge PACE Commercial |
$275.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$275.50
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.79
|
| Rate for Payer: United Healthcare All Other HMO |
$201.28
|
| Rate for Payer: United Healthcare HMO Rider |
$196.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
OP
|
$1,621.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$94.69 |
| Max. Negotiated Rate |
$1,458.90 |
| Rate for Payer: Adventist Health Commercial |
$324.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$984.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$952.01
|
| Rate for Payer: Blue Shield of California Commercial |
$983.95
|
| Rate for Payer: Blue Shield of California EPN |
$643.54
|
| Rate for Payer: Cash Price |
$891.55
|
| Rate for Payer: Cash Price |
$891.55
|
| Rate for Payer: Cash Price |
$891.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.80
|
| Rate for Payer: Cigna of CA HMO |
$1,037.44
|
| Rate for Payer: Cigna of CA PPO |
$1,199.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.40
|
| Rate for Payer: EPIC Health Plan Senior |
$648.40
|
| Rate for Payer: Galaxy Health WC |
$1,377.85
|
| Rate for Payer: Global Benefits Group Commercial |
$972.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.69
|
| Rate for Payer: InnovAge PACE Commercial |
$810.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,081.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.70
|
| Rate for Payer: Multiplan Commercial |
$1,215.75
|
| Rate for Payer: Networks By Design Commercial |
$1,053.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.85
|
| Rate for Payer: Riverside University Health System MISP |
$648.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.85
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
IP
|
$1,621.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$1,458.90 |
| Rate for Payer: Adventist Health Commercial |
$324.20
|
| Rate for Payer: Cash Price |
$891.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.40
|
| Rate for Payer: EPIC Health Plan Senior |
$648.40
|
| Rate for Payer: Galaxy Health WC |
$1,377.85
|
| Rate for Payer: Global Benefits Group Commercial |
$972.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,081.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,003.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.20
|
| Rate for Payer: Multiplan Commercial |
$1,215.75
|
| Rate for Payer: Networks By Design Commercial |
$1,053.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.85
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$3,127.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
906820201
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$625.40 |
| Max. Negotiated Rate |
$2,814.30 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.80
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,935.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,461.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,993.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,561.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,613.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.23
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: Cigna of CA HMO |
$1,701.12
|
| Rate for Payer: Cigna of CA PPO |
$1,966.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,259.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,259.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,329.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,772.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,012.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,645.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,860.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,860.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,063.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,594.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,594.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,329.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,259.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,259.30
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$3,127.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
906820201
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$625.40 |
| Max. Negotiated Rate |
$2,814.30 |
| Rate for Payer: Adventist Health Commercial |
$625.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,657.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,719.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,345.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,836.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,898.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,241.42
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Cash Price |
$1,719.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,001.28
|
| Rate for Payer: Cigna of CA PPO |
$2,313.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,657.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,657.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,657.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,250.80
|
| Rate for Payer: Galaxy Health WC |
$2,657.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,876.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,814.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,563.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,085.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,191.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,935.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,188.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,188.90
|
| Rate for Payer: Multiplan Commercial |
$2,345.25
|
| Rate for Payer: Networks By Design Commercial |
$2,032.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,657.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,250.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,876.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,876.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,563.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,563.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,563.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,657.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,657.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,657.95
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$2,392.20 |
| Rate for Payer: Adventist Health Commercial |
$531.60
|
| Rate for Payer: Cash Price |
$1,461.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,063.20
|
| Rate for Payer: Galaxy Health WC |
$2,259.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,594.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,392.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,772.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,012.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,645.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.60
|
| Rate for Payer: Multiplan Commercial |
$1,993.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,259.30
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
OP
|
$2,846.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$225.49 |
| Max. Negotiated Rate |
$2,561.40 |
| Rate for Payer: Adventist Health Commercial |
$569.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,728.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$917.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,671.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,727.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,129.86
|
| Rate for Payer: Cash Price |
$1,565.30
|
| Rate for Payer: Cash Price |
$1,565.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,276.80
|
| Rate for Payer: Cigna of CA HMO |
$1,821.44
|
| Rate for Payer: Cigna of CA PPO |
$2,106.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,419.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,707.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,561.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,898.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,134.50
|
| Rate for Payer: Networks By Design Commercial |
$1,849.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.10
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,707.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,707.60
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
IP
|
$2,846.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$2,561.40 |
| Rate for Payer: Adventist Health Commercial |
$569.20
|
| Rate for Payer: Cash Price |
$1,565.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,276.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,138.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,138.40
|
| Rate for Payer: Galaxy Health WC |
$2,419.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,707.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,561.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,898.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,084.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,761.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.20
|
| Rate for Payer: Multiplan Commercial |
$2,134.50
|
| Rate for Payer: Networks By Design Commercial |
$1,849.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,419.10
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,095.30 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$669.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$589.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.74
|
| Rate for Payer: Blue Shield of California Commercial |
$743.59
|
| Rate for Payer: Blue Shield of California EPN |
$485.58
|
| Rate for Payer: Cash Price |
$669.35
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,034.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,034.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| Rate for Payer: InnovAge PACE Commercial |
$608.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$753.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$851.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$851.90
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Riverside University Health System MISP |
$486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.74
|
| Rate for Payer: United Healthcare All Other HMO |
$444.57
|
| Rate for Payer: United Healthcare HMO Rider |
$434.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,034.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,034.45
|
|
|
HC 59 FE CHLORIDE
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT A4641
|
| Hospital Charge Code |
909301497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,095.30 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Blue Shield of California Commercial |
$940.74
|
| Rate for Payer: Blue Shield of California EPN |
$613.37
|
| Rate for Payer: Cash Price |
$669.35
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Cigna of CA HMO |
$851.90
|
| Rate for Payer: Cigna of CA PPO |
$851.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$753.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.40
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$608.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.74
|
| Rate for Payer: United Healthcare All Other HMO |
$444.57
|
| Rate for Payer: United Healthcare HMO Rider |
$434.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.57
|
|
