|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
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/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$81.67
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$75.47 |
| Rate for Payer: Adventist Health Commercial |
$16.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.25
|
| 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 |
$44.92
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cigna of CA HMO |
$57.17
|
| Rate for Payer: Cigna of CA PPO |
$57.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.67
|
| Rate for Payer: EPIC Health Plan Senior |
$32.67
|
| Rate for Payer: Galaxy Health WC |
$69.42
|
| Rate for Payer: Global Benefits Group Commercial |
$49.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.17
|
| Rate for Payer: Multiplan Commercial |
$65.34
|
| Rate for Payer: Networks By Design Commercial |
$40.84
|
| Rate for Payer: Prime Health Services Commercial |
$69.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.65
|
| Rate for Payer: United Healthcare All Other HMO |
$29.83
|
| Rate for Payer: United Healthcare HMO Rider |
$29.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.42
|
| Rate for Payer: Vantage Medical Group Senior |
$69.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$81.67
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$69.42 |
| Rate for Payer: Adventist Health Commercial |
$16.33
|
| Rate for Payer: Blue Shield of California Commercial |
$60.27
|
| Rate for Payer: Blue Shield of California EPN |
$39.69
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cigna of CA HMO |
$57.17
|
| Rate for Payer: Cigna of CA PPO |
$57.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.67
|
| Rate for Payer: EPIC Health Plan Senior |
$32.67
|
| Rate for Payer: Galaxy Health WC |
$69.42
|
| Rate for Payer: Global Benefits Group Commercial |
$49.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$65.34
|
| Rate for Payer: Networks By Design Commercial |
$40.84
|
| Rate for Payer: Prime Health Services Commercial |
$69.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.65
|
| Rate for Payer: United Healthcare All Other HMO |
$29.83
|
| Rate for Payer: United Healthcare HMO Rider |
$29.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.75
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$85.79
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$186.57 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.57
|
| Rate for Payer: Blue Shield of California Commercial |
$82.42
|
| Rate for Payer: Blue Shield of California EPN |
$82.42
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cigna of CA HMO |
$60.05
|
| Rate for Payer: Cigna of CA PPO |
$60.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.92
|
| Rate for Payer: Global Benefits Group Commercial |
$51.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.05
|
| Rate for Payer: Multiplan Commercial |
$68.63
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$72.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.20
|
| Rate for Payer: United Healthcare All Other HMO |
$31.34
|
| Rate for Payer: United Healthcare HMO Rider |
$30.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.92
|
| Rate for Payer: Vantage Medical Group Senior |
$72.92
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$85.79
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Blue Shield of California Commercial |
$63.31
|
| Rate for Payer: Blue Shield of California EPN |
$41.69
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cigna of CA HMO |
$60.05
|
| Rate for Payer: Cigna of CA PPO |
$60.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.92
|
| Rate for Payer: Global Benefits Group Commercial |
$51.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.59
|
| Rate for Payer: Multiplan Commercial |
$68.63
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$72.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.20
|
| Rate for Payer: United Healthcare All Other HMO |
$31.34
|
| Rate for Payer: United Healthcare HMO Rider |
$30.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.10
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Adventist Health Commercial |
$44.65
|
| Rate for Payer: Blue Shield of California Commercial |
$164.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.50
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Cigna of CA HMO |
$156.28
|
| Rate for Payer: Cigna of CA PPO |
$156.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.30
|
| Rate for Payer: EPIC Health Plan Senior |
$89.30
|
| Rate for Payer: Galaxy Health WC |
$189.76
|
| Rate for Payer: Global Benefits Group Commercial |
$133.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$178.60
|
| Rate for Payer: Networks By Design Commercial |
$111.62
|
| Rate for Payer: Prime Health Services Commercial |
$189.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.79
|
| Rate for Payer: United Healthcare All Other HMO |
$81.55
|
| Rate for Payer: United Healthcare HMO Rider |
$79.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.11
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$223.25
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Adventist Health Commercial |
$44.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.07
|
| Rate for Payer: Blue Shield of California Commercial |
$224.00
|
| Rate for Payer: Blue Shield of California EPN |
$224.00
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Cigna of CA HMO |
$156.28
|
| Rate for Payer: Cigna of CA PPO |
$156.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.30
|
| Rate for Payer: EPIC Health Plan Senior |
$89.30
|
| Rate for Payer: Galaxy Health WC |
$189.76
|
| Rate for Payer: Global Benefits Group Commercial |
$133.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.28
|
| Rate for Payer: Multiplan Commercial |
$178.60
|
| Rate for Payer: Networks By Design Commercial |
$111.62
|
| Rate for Payer: Prime Health Services Commercial |
$189.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.79
|
| Rate for Payer: United Healthcare All Other HMO |
$81.55
|
| Rate for Payer: United Healthcare HMO Rider |
$79.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.76
|
| Rate for Payer: Vantage Medical Group Senior |
$189.76
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$239.69
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$279.77 |
| Rate for Payer: Adventist Health Commercial |
$47.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.77
|
| Rate for Payer: Blue Shield of California Commercial |
$116.81
|
| Rate for Payer: Blue Shield of California EPN |
$116.81
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Cigna of CA HMO |
$167.78
|
| Rate for Payer: Cigna of CA PPO |
$167.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.88
|
| Rate for Payer: EPIC Health Plan Senior |
$95.88
|
| Rate for Payer: Galaxy Health WC |
$203.74
|
| Rate for Payer: Global Benefits Group Commercial |
$143.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.78
|
| Rate for Payer: Multiplan Commercial |
$191.75
|
| Rate for Payer: Networks By Design Commercial |
$119.84
|
| Rate for Payer: Prime Health Services Commercial |
$203.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$87.56
|
| Rate for Payer: United Healthcare HMO Rider |
$85.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.74
|
| Rate for Payer: Vantage Medical Group Senior |
$203.74
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$239.69
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$203.74 |
| Rate for Payer: Adventist Health Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$176.89
|
| Rate for Payer: Blue Shield of California EPN |
$116.49
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Cigna of CA HMO |
$167.78
|
| Rate for Payer: Cigna of CA PPO |
$167.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.88
|
| Rate for Payer: EPIC Health Plan Senior |
$95.88
|
| Rate for Payer: Galaxy Health WC |
$203.74
|
| Rate for Payer: Global Benefits Group Commercial |
$143.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.53
|
| Rate for Payer: Multiplan Commercial |
$191.75
|
| Rate for Payer: Networks By Design Commercial |
$119.84
|
| Rate for Payer: Prime Health Services Commercial |
$203.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$87.56
|
| Rate for Payer: United Healthcare HMO Rider |
$85.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$4.79
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
IP
|
$736.46
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$625.99 |
| Rate for Payer: Adventist Health Commercial |
$147.29
|
| Rate for Payer: Blue Shield of California Commercial |
$543.51
|
| Rate for Payer: Blue Shield of California EPN |
$357.92
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cigna of CA HMO |
$515.52
|
| Rate for Payer: Cigna of CA PPO |
$515.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.58
|
| Rate for Payer: EPIC Health Plan Senior |
$294.58
|
| Rate for Payer: Galaxy Health WC |
$625.99
|
| Rate for Payer: Global Benefits Group Commercial |
$441.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.75
|
| Rate for Payer: Multiplan Commercial |
$589.17
|
| Rate for Payer: Networks By Design Commercial |
$368.23
|
| Rate for Payer: Prime Health Services Commercial |
$625.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.39
|
| Rate for Payer: United Healthcare All Other HMO |
$269.03
|
| Rate for Payer: United Healthcare HMO Rider |
$263.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.19
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
OP
|
$736.46
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$835.26 |
| Rate for Payer: Adventist Health Commercial |
$147.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$483.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$835.26
|
| Rate for Payer: Blue Shield of California Commercial |
$368.98
|
| Rate for Payer: Blue Shield of California EPN |
$368.98
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cigna of CA HMO |
$515.52
|
| Rate for Payer: Cigna of CA PPO |
$515.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$625.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$625.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.58
|
| Rate for Payer: EPIC Health Plan Senior |
$294.58
|
| Rate for Payer: Galaxy Health WC |
$625.99
|
| Rate for Payer: Global Benefits Group Commercial |
$441.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$523.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.52
|
| Rate for Payer: Multiplan Commercial |
$589.17
|
| Rate for Payer: Networks By Design Commercial |
$368.23
|
| Rate for Payer: Prime Health Services Commercial |
$625.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$441.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$441.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.39
|
| Rate for Payer: United Healthcare All Other HMO |
$269.03
|
| Rate for Payer: United Healthcare HMO Rider |
$263.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$625.99
|
| Rate for Payer: Vantage Medical Group Senior |
$625.99
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.64
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.86
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$3.78
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$2.65
|
| Rate for Payer: Cigna of CA PPO |
$2.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Blue Shield of California EPN |
$1.84
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cigna of CA HMO |
$2.65
|
| Rate for Payer: Cigna of CA PPO |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.91
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
IP
|
$66.96
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Blue Shield of California Commercial |
$49.42
|
| Rate for Payer: Blue Shield of California EPN |
$32.54
|
| Rate for Payer: Cash Price |
$36.83
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$53.57
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.13
|
| Rate for Payer: United Healthcare All Other HMO |
$24.46
|
| Rate for Payer: United Healthcare HMO Rider |
$23.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.93
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
OP
|
$66.96
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Adventist Health Commercial |
$13.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.45
|
| Rate for Payer: Cash Price |
$36.83
|
| Rate for Payer: Cash Price |
$36.83
|
| Rate for Payer: Cigna of CA HMO |
$46.87
|
| Rate for Payer: Cigna of CA PPO |
$46.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$56.92
|
| Rate for Payer: Global Benefits Group Commercial |
$40.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$53.57
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$56.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.13
|
| Rate for Payer: United Healthcare All Other HMO |
$24.46
|
| Rate for Payer: United Healthcare HMO Rider |
$23.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.92
|
| Rate for Payer: Vantage Medical Group Senior |
$56.92
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 51079-074-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Adventist Health Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna of CA HMO |
$0.20
|
| Rate for Payer: Cigna of CA PPO |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: EPIC Health Plan Senior |
$0.11
|
| Rate for Payer: Galaxy Health WC |
$0.24
|
| 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 Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.22
|
| Rate for Payer: Networks By Design Commercial |
$0.18
|
| Rate for Payer: Prime Health Services Commercial |
$0.24
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 50228-182-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Other HMO |
$0.02
|
| Rate for Payer: United Healthcare HMO Rider |
$0.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Vantage Medical Group Senior |
$0.03
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 50111-398-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 68084-447-11
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| 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 |
$0.15
|
| 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 |
$0.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.16
|
| 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 |
$0.09
|
| Rate for Payer: EPIC Health Plan Senior |
$0.09
|
| 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 |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.15
|
| 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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 60687-811-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.26
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 50228-182-01
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California EPN |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna of CA HMO |
$0.03
|
| Rate for Payer: Cigna of CA PPO |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.03
|
| Rate for Payer: Global Benefits Group Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: Networks By Design Commercial |
$0.03
|
| Rate for Payer: Prime Health Services Commercial |
$0.03
|
|
