|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 6425333330
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SOLUTION [408117967]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 9994-0819-20
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 8290306424
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO |
$0.11
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 6380760005
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 6380760005
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.15
|
| Rate for Payer: Cigna of CA PPO |
$0.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO |
$0.12
|
| Rate for Payer: United Healthcare HMO Rider |
$0.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 8290306424
|
| Hospital Charge Code |
901700017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Senior |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.11
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [105460]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.12
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.10
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.24
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.24
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California EPN |
$4.67
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$6.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.68
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.14
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE [117969]
|
Facility
|
IP
|
$7.96
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.77 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.87
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$5.57
|
| Rate for Payer: Cigna of CA PPO |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.37
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.61
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE [117969]
|
Facility
|
OP
|
$7.96
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna of CA HMO |
$5.57
|
| Rate for Payer: Cigna of CA PPO |
$5.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.37
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.77
|
| Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$10.63
|
| Rate for Payer: Blue Shield of California EPN |
$7.00
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.50
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$11.52
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
IP
|
$157.12
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$133.55 |
| Rate for Payer: Adventist Health Commercial |
$31.42
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$76.36
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Cigna of CA HMO |
$109.98
|
| Rate for Payer: Cigna of CA PPO |
$109.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.85
|
| Rate for Payer: EPIC Health Plan Senior |
$62.85
|
| Rate for Payer: Galaxy Health WC |
$133.55
|
| Rate for Payer: Global Benefits Group Commercial |
$94.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.71
|
| Rate for Payer: Multiplan Commercial |
$125.70
|
| Rate for Payer: Networks By Design Commercial |
$78.56
|
| Rate for Payer: Prime Health Services Commercial |
$133.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.97
|
| Rate for Payer: United Healthcare All Other HMO |
$57.40
|
| Rate for Payer: United Healthcare HMO Rider |
$56.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.46
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
OP
|
$157.12
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$359.07 |
| Rate for Payer: Adventist Health Commercial |
$31.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.07
|
| Rate for Payer: Blue Shield of California Commercial |
$151.14
|
| Rate for Payer: Blue Shield of California EPN |
$151.14
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Cigna of CA HMO |
$109.98
|
| Rate for Payer: Cigna of CA PPO |
$109.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.85
|
| Rate for Payer: EPIC Health Plan Senior |
$62.85
|
| Rate for Payer: Galaxy Health WC |
$133.55
|
| Rate for Payer: Global Benefits Group Commercial |
$94.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.98
|
| Rate for Payer: Multiplan Commercial |
$125.70
|
| Rate for Payer: Networks By Design Commercial |
$78.56
|
| Rate for Payer: Prime Health Services Commercial |
$133.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.97
|
| Rate for Payer: United Healthcare All Other HMO |
$57.40
|
| Rate for Payer: United Healthcare HMO Rider |
$56.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.55
|
| Rate for Payer: Vantage Medical Group Senior |
$133.55
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
OP
|
$102.48
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$220.55 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.55
|
| Rate for Payer: Blue Shield of California Commercial |
$97.43
|
| Rate for Payer: Blue Shield of California EPN |
$97.43
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cigna of CA HMO |
$71.74
|
| Rate for Payer: Cigna of CA PPO |
$71.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.99
|
| Rate for Payer: EPIC Health Plan Senior |
$40.99
|
| Rate for Payer: Galaxy Health WC |
$87.11
|
| Rate for Payer: Global Benefits Group Commercial |
$61.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.74
|
| Rate for Payer: Multiplan Commercial |
$81.98
|
| Rate for Payer: Networks By Design Commercial |
$51.24
|
| Rate for Payer: Prime Health Services Commercial |
$87.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.46
|
| Rate for Payer: United Healthcare All Other HMO |
$37.44
|
| Rate for Payer: United Healthcare HMO Rider |
$36.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.11
|
| Rate for Payer: Vantage Medical Group Senior |
$87.11
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
IP
|
$102.48
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$87.11 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Blue Shield of California Commercial |
$75.63
|
| Rate for Payer: Blue Shield of California EPN |
$49.81
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cigna of CA HMO |
$71.74
|
| Rate for Payer: Cigna of CA PPO |
$71.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.99
|
| Rate for Payer: EPIC Health Plan Senior |
$40.99
|
| Rate for Payer: Galaxy Health WC |
$87.11
|
| Rate for Payer: Global Benefits Group Commercial |
$61.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$81.98
|
| Rate for Payer: Networks By Design Commercial |
$51.24
|
| Rate for Payer: Prime Health Services Commercial |
$87.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.46
|
| Rate for Payer: United Healthcare All Other HMO |
$37.44
|
| Rate for Payer: United Healthcare HMO Rider |
$36.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.56
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
IP
|
$189.69
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$161.24 |
| Rate for Payer: Adventist Health Commercial |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$139.99
|
| Rate for Payer: Blue Shield of California EPN |
$92.19
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Cigna of CA HMO |
$132.78
|
| Rate for Payer: Cigna of CA PPO |
$132.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.88
|
| Rate for Payer: Galaxy Health WC |
$161.24
|
| Rate for Payer: Global Benefits Group Commercial |
$113.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.53
|
| Rate for Payer: Multiplan Commercial |
$151.75
|
| Rate for Payer: Networks By Design Commercial |
$94.84
|
| Rate for Payer: Prime Health Services Commercial |
$161.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.19
|
| Rate for Payer: United Healthcare All Other HMO |
$69.29
|
| Rate for Payer: United Healthcare HMO Rider |
$67.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.12
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
OP
|
$189.69
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Adventist Health Commercial |
$37.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$429.40
|
| Rate for Payer: Blue Shield of California Commercial |
$180.66
|
| Rate for Payer: Blue Shield of California EPN |
$180.66
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Cigna of CA HMO |
$132.78
|
| Rate for Payer: Cigna of CA PPO |
$132.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.66
|
| Rate for Payer: Galaxy Health WC |
$161.24
|
| Rate for Payer: Global Benefits Group Commercial |
$113.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.09
|
| Rate for Payer: Multiplan Commercial |
$151.75
|
| Rate for Payer: Networks By Design Commercial |
$94.84
|
| Rate for Payer: Prime Health Services Commercial |
$161.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.19
|
| Rate for Payer: United Healthcare All Other HMO |
$69.29
|
| Rate for Payer: United Healthcare HMO Rider |
$67.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$143.73
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$373.80
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$423.09 |
| Rate for Payer: Adventist Health Commercial |
$74.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$423.09
|
| Rate for Payer: Blue Shield of California Commercial |
$177.16
|
| Rate for Payer: Blue Shield of California EPN |
$177.16
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Cigna of CA HMO |
$261.66
|
| Rate for Payer: Cigna of CA PPO |
$261.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.52
|
| Rate for Payer: EPIC Health Plan Senior |
$149.52
|
| Rate for Payer: Galaxy Health WC |
$317.73
|
| Rate for Payer: Global Benefits Group Commercial |
$224.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.66
|
| Rate for Payer: Multiplan Commercial |
$299.04
|
| Rate for Payer: Networks By Design Commercial |
$186.90
|
| Rate for Payer: Prime Health Services Commercial |
$317.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.29
|
| Rate for Payer: United Healthcare All Other HMO |
$136.55
|
| Rate for Payer: United Healthcare HMO Rider |
$133.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.73
|
| Rate for Payer: Vantage Medical Group Senior |
$317.73
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$373.80
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$317.73 |
| Rate for Payer: Adventist Health Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$275.86
|
| Rate for Payer: Blue Shield of California EPN |
$181.67
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Cigna of CA HMO |
$261.66
|
| Rate for Payer: Cigna of CA PPO |
$261.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.52
|
| Rate for Payer: EPIC Health Plan Senior |
$149.52
|
| Rate for Payer: Galaxy Health WC |
$317.73
|
| Rate for Payer: Global Benefits Group Commercial |
$224.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.71
|
| Rate for Payer: Multiplan Commercial |
$299.04
|
| Rate for Payer: Networks By Design Commercial |
$186.90
|
| Rate for Payer: Prime Health Services Commercial |
$317.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.29
|
| Rate for Payer: United Healthcare All Other HMO |
$136.55
|
| Rate for Payer: United Healthcare HMO Rider |
$133.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Blue Shield of California Commercial |
$50.48
|
| Rate for Payer: Blue Shield of California EPN |
$33.24
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$75.47 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Blue Shield of California EPN |
$33.34
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.88
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.14
|
| Rate for Payer: Vantage Medical Group Senior |
$58.14
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Blue Shield of California Commercial |
$50.48
|
| Rate for Payer: Blue Shield of California EPN |
$33.24
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$54.72
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
|
