|
HALOPERIDOL 2 MG TABLET [3581]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 51079-735-01
|
| Hospital Charge Code |
1710022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.46
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.45
|
| Rate for Payer: Heritage Provider Network Senior |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
|
|
HALOPERIDOL 2 MG TABLET [3581]
|
Facility
|
IP
|
$0.61
|
|
|
Service Code
|
NDC 0378-0214-01
|
| Hospital Charge Code |
1710022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.42
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 60687-161-11
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
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 |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
NDC 51079-736-01
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 51079-736-01
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Senior |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 60687-161-11
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Senior |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 51079-736-20
|
| Hospital Charge Code |
1710044
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Senior |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
OP
|
$52.80
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1722029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$64.27 |
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.27
|
| 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 |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.27
|
| Rate for Payer: Blue Shield of California Commercial |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$22.05
|
| Rate for Payer: Blue Shield of California EPN |
$22.05
|
| Rate for Payer: Blue Shield of California EPN |
$22.05
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.88
|
| Rate for Payer: Dignity Health Senior |
$44.88
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$23.34
|
| Rate for Payer: Heritage Provider Network Senior |
$24.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.12
|
| Rate for Payer: TriValley Medical Group Senior |
$20.16
|
| Rate for Payer: TriValley Medical Group Senior |
$21.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.88
|
| Rate for Payer: Vantage Medical Group Senior |
$44.88
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION [10162]
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
CPT J1631
|
| Hospital Charge Code |
1722029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$10.08
|
| Rate for Payer: Adventist Health Commercial |
$10.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.27
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cash Price |
$23.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Senior |
$35.75
|
| Rate for Payer: Heritage Provider Network Senior |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$39.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.84
|
|
|
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 |
$6.10 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.15
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.81
|
| Rate for Payer: Heritage Provider Network Senior |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.26
|
|
|
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 |
$6.10 |
| Max. Negotiated Rate |
$64.27 |
| Rate for Payer: Adventist Health Commercial |
$6.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.15
|
| 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 |
$25.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.27
|
| Rate for Payer: Blue Shield of California Commercial |
$22.05
|
| Rate for Payer: Blue Shield of California EPN |
$22.05
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.64
|
| Rate for Payer: Dignity Health Senior |
$28.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Senior |
$15.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Vantage Medical Group Senior |
$28.64
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$7.19
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
1720105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1.30
|
| Rate for Payer: Heritage Provider Network Senior |
$0.72
|
| Rate for Payer: Heritage Provider Network Senior |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.64
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
OP
|
$7.19
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
1720105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$14.96 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$14.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.96
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| 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 |
$0.86
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.90
|
| Rate for Payer: Dignity Health Senior |
$6.11
|
| Rate for Payer: Dignity Health Senior |
$0.90
|
| Rate for Payer: Dignity Health Senior |
$1.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.89
|
| Rate for Payer: Heritage Provider Network Senior |
$3.33
|
| Rate for Payer: Heritage Provider Network Senior |
$0.49
|
| Rate for Payer: Heritage Provider Network Senior |
$0.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.42
|
| Rate for Payer: TriValley Medical Group Senior |
$2.88
|
| Rate for Payer: TriValley Medical Group Senior |
$0.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$0.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.63
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$14,914.49
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$14,914.49 |
| Max. Negotiated Rate |
$14,914.49 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,914.49
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$27,207.42
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$27,207.42 |
| Max. Negotiated Rate |
$27,207.42 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,207.42
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$9,664.42
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$9,664.42 |
| Max. Negotiated Rate |
$9,664.42 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,664.42
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$7,158.27
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$7,158.27 |
| Max. Negotiated Rate |
$7,158.27 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,158.27
|
|
|
HB COVID-19 RNA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.99
|
| Rate for Payer: Blue Shield of California Commercial |
$35.40
|
| Rate for Payer: Blue Shield of California EPN |
$33.46
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Humana Medicare |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| 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 |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
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 |
$9.05 |
| Max. Negotiated Rate |
$247.78 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.78
|
| Rate for Payer: Blue Shield of California Commercial |
$231.20
|
| Rate for Payer: Blue Shield of California EPN |
$180.74
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.30
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.60
|
| Rate for Payer: TriValley Medical Group Senior |
$29.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.97
|
| 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
|
$71.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$53.25 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.78
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.07
|
| Rate for Payer: Heritage Provider Network Senior |
$48.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
|
|
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 |
$407.25 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| 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 |
$2,039.25
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,767.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: Dignity Health Senior |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,767.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,683.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,683.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,310.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| 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
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201370
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$139.37 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$423.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$577.50
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$654.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$654.50
|
| Rate for Payer: Dignity Health Senior |
$654.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$476.63
|
| Rate for Payer: Heritage Provider Network Senior |
$476.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$371.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.50
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$654.50
|
| Rate for Payer: Vantage Medical Group Senior |
$654.50
|
|
|
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 |
$492.14 |
| Max. Negotiated Rate |
$2,039.25 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,840.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,840.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
|
