|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 51079-736-20
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.58
|
| Rate for Payer: Cash Price |
$0.49
|
| 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: 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: 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
|
OP
|
$50.40
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1722029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$65.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.88
|
| 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 |
$29.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Blue Distinction Transplant |
$30.24
|
| Rate for Payer: Blue Distinction Transplant |
$31.68
|
| Rate for Payer: Blue Shield of California Commercial |
$29.32
|
| Rate for Payer: Blue Shield of California Commercial |
$29.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.65
|
| Rate for Payer: Blue Shield of California EPN |
$26.65
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| 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 |
$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 Media |
$42.84
|
| Rate for Payer: Dignity Health Media |
$44.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.12
|
| Rate for Payer: Galaxy Health WC |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$44.88
|
| Rate for Payer: Global Benefits Group Commercial |
$31.68
|
| Rate for Payer: Global Benefits Group Commercial |
$30.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$44.88
|
| Rate for Payer: 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 |
$30.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.40
|
| Rate for Payer: United Healthcare All Other HMO |
$26.40
|
| Rate for Payer: United Healthcare All Other HMO |
$25.20
|
| Rate for Payer: United Healthcare HMO Rider |
$25.20
|
| Rate for Payer: United Healthcare HMO Rider |
$26.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.20
|
| 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 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1722029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$39.60
|
| Rate for Payer: Blue Shield of California EPN |
$28.20
|
| Rate for Payer: Blue Shield of California EPN |
$26.91
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| 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 |
$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 Transplant |
$21.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.16
|
| 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 |
$47.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.20
|
| 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 |
$26.40
|
| Rate for Payer: Networks By Design Commercial |
$25.20
|
| Rate for Payer: Prime Health Services Commercial |
$44.88
|
| Rate for Payer: Prime Health Services Commercial |
$42.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.03
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$19.47
|
| Rate for Payer: United Healthcare HMO Rider |
$19.05
|
| Rate for Payer: United Healthcare HMO Rider |
$18.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.42
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
OP
|
$33.70
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1720525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$65.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Blue Distinction Transplant |
$20.22
|
| Rate for Payer: Blue Shield of California Commercial |
$29.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.65
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: 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 Media |
$28.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.48
|
| Rate for Payer: Galaxy Health WC |
$28.64
|
| Rate for Payer: Global Benefits Group Commercial |
$20.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| 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 |
$16.85
|
| Rate for Payer: United Healthcare All Other HMO |
$16.85
|
| Rate for Payer: United Healthcare HMO Rider |
$16.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.85
|
| Rate for Payer: Vantage Medical Group 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
|
CPT J1631
|
| Hospital Charge Code |
1720525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$30.33 |
| Rate for Payer: Blue Shield of California Commercial |
$25.28
|
| Rate for Payer: Blue Shield of California EPN |
$18.00
|
| Rate for Payer: Cash Price |
$15.17
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: Networks By Design Commercial |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$28.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.73
|
| Rate for Payer: United Healthcare All Other HMO |
$12.43
|
| Rate for Payer: United Healthcare HMO Rider |
$12.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
1720105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.95
|
| 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 Medicare Advantage/Dual Product |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.17
|
| Rate for Payer: Blue Distinction Transplant |
$1.15
|
| Rate for Payer: Blue Distinction Transplant |
$4.31
|
| Rate for Payer: Blue Distinction Transplant |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.54
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Blue Shield of California EPN |
$4.13
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Central Health Plan Commercial |
$1.54
|
| Rate for Payer: Central Health Plan Commercial |
$5.75
|
| Rate for Payer: Central Health Plan Commercial |
$0.85
|
| Rate for Payer: Cigna of CA HMO |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Media |
$0.90
|
| Rate for Payer: Dignity Health Media |
$6.11
|
| Rate for Payer: Dignity Health Media |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Global Benefits Group Commercial |
$4.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Global Benefits Group Commercial |
$1.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.16
|
| 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 |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| 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: 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 |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Riverside University Health System MISP |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$2.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO |
$0.53
|
| Rate for Payer: United Healthcare All Other HMO |
$0.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3.60
|
| Rate for Payer: United Healthcare HMO Rider |
$0.96
|
| Rate for Payer: United Healthcare HMO Rider |
$0.53
|
| Rate for Payer: United Healthcare HMO Rider |
$3.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$7.19
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
1720105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Blue Shield of California Commercial |
$5.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$1.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$0.48
|
| 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 |
$0.74
|
| Rate for Payer: Cigna of CA HMO |
$1.34
|
| Rate for Payer: Cigna of CA HMO |
$5.03
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Cigna of CA PPO |
$1.34
|
| Rate for Payer: Cigna of CA PPO |
$5.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.88
|
| Rate for Payer: Galaxy Health WC |
$6.11
|
| Rate for Payer: Galaxy Health WC |
$1.63
|
| Rate for Payer: Galaxy Health WC |
$0.90
|
| 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 |
$0.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.47
|
| 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 |
$2.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| 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: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Networks By Design Commercial |
$3.60
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Networks By Design Commercial |
$0.53
|
| Rate for Payer: Prime Health Services Commercial |
$6.11
|
| Rate for Payer: Prime Health Services Commercial |
$1.63
|
| Rate for Payer: Prime Health Services Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Other HMO |
$2.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.71
|
| Rate for Payer: United Healthcare All Other HMO |
$0.39
|
| Rate for Payer: United Healthcare HMO Rider |
$0.38
|
| Rate for Payer: United Healthcare HMO Rider |
$0.69
|
| Rate for Payer: United Healthcare HMO Rider |
$2.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.37
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$48,498.81
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$30,630.83 |
| Max. Negotiated Rate |
$48,498.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,630.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,501.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,498.81
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$17,227.40
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$10,880.46 |
| Max. Negotiated Rate |
$17,227.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,880.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,965.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,227.40
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$12,760.04
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$8,058.97 |
| Max. Negotiated Rate |
$12,760.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,058.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,603.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,760.04
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$26,585.94
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$16,791.12 |
| Max. Negotiated Rate |
$26,585.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,791.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,009.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,585.94
|
|
|
HB COVID-19 RNA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$320.15 |
| 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 |
$76.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.15
|
| Rate for Payer: Blue Distinction Transplant |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$35.23
|
| Rate for Payer: Blue Shield of California EPN |
$27.70
|
| Rate for Payer: Caremore Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Media |
$51.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| 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 |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| 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 |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HB COVID-19 RNA
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC 25 CH VITAMIN D2 D3
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$262.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.27
|
| 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 |
$262.68
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Media |
$29.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.84
|
| 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 |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| 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 |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| 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 |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC 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: Blue Shield of California EPN |
$294.23
|
| Rate for Payer: Cash Price |
$247.95
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$110.20
|
| 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: United Healthcare All Other Commercial |
$208.06
|
| Rate for Payer: United Healthcare All Other HMO |
$203.21
|
| Rate for Payer: United Healthcare HMO Rider |
$198.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.83
|
|
|
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 |
$192.85 |
| Max. Negotiated Rate |
$495.90 |
| 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 |
$303.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.53
|
| Rate for Payer: Blue Distinction Transplant |
$330.60
|
| Rate for Payer: Blue Shield of California Commercial |
$413.25
|
| Rate for Payer: Blue Shield of California EPN |
$299.74
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| 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 Media |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$413.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.85
|
| 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: LLUH Dept of Risk Management WC |
$225.91
|
| 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 |
$275.50
|
| Rate for Payer: United Healthcare All Other HMO |
$275.50
|
| Rate for Payer: United Healthcare HMO Rider |
$275.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.50
|
| 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
|
IP
|
$2,007.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$401.40 |
| Max. Negotiated Rate |
$1,806.30 |
| Rate for Payer: Cash Price |
$903.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,605.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.80
|
| Rate for Payer: Galaxy Health WC |
$1,705.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,204.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,806.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,338.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$764.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.40
|
| Rate for Payer: Multiplan Commercial |
$1,505.25
|
| Rate for Payer: Networks By Design Commercial |
$1,304.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,705.95
|
|
|
HC 3D ECHO IMG CGEN CAR ANOMAL
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
CPT 93319
|
| Hospital Charge Code |
900200319
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$1,806.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$147.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,705.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,103.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,103.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,185.74
|
| Rate for Payer: Blue Distinction Transplant |
$1,204.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,240.33
|
| Rate for Payer: Blue Shield of California EPN |
$975.40
|
| Rate for Payer: Cash Price |
$903.15
|
| Rate for Payer: Cash Price |
$903.15
|
| Rate for Payer: Cash Price |
$903.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,605.60
|
| Rate for Payer: Cigna of CA HMO |
$1,284.48
|
| Rate for Payer: Cigna of CA PPO |
$1,485.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,705.95
|
| Rate for Payer: Dignity Health Media |
$1,705.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,705.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$802.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.80
|
| Rate for Payer: Galaxy Health WC |
$1,705.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,204.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,806.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,505.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$702.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,338.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.40
|
| Rate for Payer: Multiplan Commercial |
$1,505.25
|
| Rate for Payer: Networks By Design Commercial |
$1,304.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,705.95
|
| Rate for Payer: Riverside University Health System MISP |
$802.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,204.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,204.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$935.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$724.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,705.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,705.95
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.39
|
| Rate for Payer: Blue Distinction Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,321.43
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Media |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,039.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$951.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,087.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
906820201
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
906820201
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,606.39
|
| Rate for Payer: Blue Distinction Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,680.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,321.43
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Media |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,039.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$951.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,087.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC 3D RENDERING W/POSTPROCESSING
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$543.80 |
| Max. Negotiated Rate |
$2,447.10 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,175.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,447.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.80
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
OP
|
$3,524.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$249.09 |
| Max. Negotiated Rate |
$3,171.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,373.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$917.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,081.98
|
| Rate for Payer: Blue Distinction Transplant |
$2,114.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,177.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,712.66
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,819.20
|
| Rate for Payer: Cigna of CA HMO |
$2,255.36
|
| Rate for Payer: Cigna of CA PPO |
$2,607.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,995.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,114.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,171.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,643.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,350.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,643.00
|
| Rate for Payer: Networks By Design Commercial |
$2,290.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,995.40
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,114.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,114.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.16
|
| Rate for Payer: United Healthcare All Other HMO |
$632.16
|
| Rate for Payer: United Healthcare HMO Rider |
$632.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC 3-PHASE BONE SCAN
|
Facility
|
IP
|
$3,524.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
909301372
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$704.80 |
| Max. Negotiated Rate |
$3,171.60 |
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,819.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Galaxy Health WC |
$2,995.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,114.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,171.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,350.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.80
|
| Rate for Payer: Multiplan Commercial |
$2,643.00
|
| Rate for Payer: Networks By Design Commercial |
$2,290.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,995.40
|
|
