|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Distinction Transplant |
$0.61
|
| Rate for Payer: Blue Distinction Transplant |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$0.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.71
|
| Rate for Payer: Cigna of CA HMO |
$1.06
|
| Rate for Payer: Cigna of CA PPO |
$0.71
|
| Rate for Payer: Cigna of CA PPO |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: Dignity Health Media |
$1.29
|
| Rate for Payer: Dignity Health Media |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.61
|
| Rate for Payer: Galaxy Health WC |
$0.86
|
| Rate for Payer: Galaxy Health WC |
$1.29
|
| Rate for Payer: Global Benefits Group Commercial |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Networks By Design Commercial |
$0.51
|
| Rate for Payer: Networks By Design Commercial |
$0.76
|
| Rate for Payer: Prime Health Services Commercial |
$1.29
|
| Rate for Payer: Prime Health Services Commercial |
$0.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.76
|
| Rate for Payer: United Healthcare All Other HMO |
$0.51
|
| Rate for Payer: United Healthcare HMO Rider |
$0.76
|
| Rate for Payer: United Healthcare HMO Rider |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Vantage Medical Group Senior |
$1.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1721146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.17
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.58
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.69
|
| Rate for Payer: Cigna of CA HMO |
$2.16
|
| Rate for Payer: Cigna of CA HMO |
$1.26
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.69
|
| Rate for Payer: Cigna of CA PPO |
$2.16
|
| Rate for Payer: Cigna of CA PPO |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.97
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$2.06
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Global Benefits Group Commercial |
$1.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$1.94
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$1.21
|
| Rate for Payer: Networks By Design Commercial |
$0.90
|
| Rate for Payer: Networks By Design Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.56
|
| Rate for Payer: Prime Health Services Commercial |
$2.62
|
| Rate for Payer: Prime Health Services Commercial |
$2.06
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1.11
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.65
|
| Rate for Payer: United Healthcare HMO Rider |
$0.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.80
|
|
|
HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [15847]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1771169
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Distinction Transplant |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Media |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [15847]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1771169
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 6380760005
|
| Hospital Charge Code |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| 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 |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.14
|
| Rate for Payer: Blue Distinction Transplant |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| 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 Media |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.20
|
| Rate for Payer: Global Benefits Group Commercial |
$0.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.18
|
| 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: 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
|
| 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
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 8290306424
|
| Hospital Charge Code |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| 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 |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| 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 Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.13
|
| 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: 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
|
| 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 |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 8290306424
|
| Hospital Charge Code |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG121687
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Blue Shield of California Commercial |
$6.84
|
| Rate for Payer: Blue Shield of California EPN |
$4.92
|
| Rate for Payer: Cash Price |
$4.32
|
| 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 Transplant |
$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: 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 |
$3.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3.54
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.17
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG121687
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| 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 |
$5.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Distinction Transplant |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$7.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.32
|
| 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 Media |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.16
|
| Rate for Payer: Global Benefits Group Commercial |
$5.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| 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: 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 |
$4.80
|
| Rate for Payer: United Healthcare All Other HMO |
$4.80
|
| Rate for Payer: United Healthcare HMO Rider |
$4.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.80
|
| 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 SYRINGE [117969]
|
Facility
|
IP
|
$7.96
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1720049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.77 |
| Rate for Payer: Blue Shield of California Commercial |
$5.67
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$3.58
|
| 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 Transplant |
$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: 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 |
$3.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.94
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.63
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE [117969]
|
Facility
|
OP
|
$7.96
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1720049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| 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 |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Distinction Transplant |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5.87
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cash Price |
$3.58
|
| 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 Media |
$6.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.77
|
| Rate for Payer: Global Benefits Group Commercial |
$4.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| 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: 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 |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| 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
|
CPT J1644
|
| Hospital Charge Code |
NDG224551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Blue Shield of California Commercial |
$10.25
|
| Rate for Payer: Blue Shield of California EPN |
$7.37
|
| Rate for Payer: Cash Price |
$6.48
|
| 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 Transplant |
$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: 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 |
$5.44
|
| Rate for Payer: United Healthcare All Other HMO |
$5.31
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG224551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.68
|
| 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 |
$7.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Distinction Transplant |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.46
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| 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 Media |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.99
|
| 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: 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 |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| 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
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$7,849.34
|
|
|
Service Code
|
APR-DRG 2791
|
| Min. Negotiated Rate |
$6,021.27 |
| Max. Negotiated Rate |
$7,849.34 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,021.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,849.34
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$30,778.40
|
|
|
Service Code
|
APR-DRG 2794
|
| Min. Negotiated Rate |
$23,610.28 |
| Max. Negotiated Rate |
$30,778.40 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,610.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,778.40
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$9,633.44
|
|
|
Service Code
|
APR-DRG 2792
|
| Min. Negotiated Rate |
$7,389.86 |
| Max. Negotiated Rate |
$9,633.44 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,389.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,633.44
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$14,742.76
|
|
|
Service Code
|
APR-DRG 2793
|
| Min. Negotiated Rate |
$11,309.25 |
| Max. Negotiated Rate |
$14,742.76 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,309.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,742.76
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
IP
|
$143.88
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
NDG118915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$122.30 |
| Rate for Payer: Blue Shield of California Commercial |
$102.44
|
| Rate for Payer: Blue Shield of California EPN |
$73.67
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna of CA HMO |
$100.72
|
| Rate for Payer: Cigna of CA PPO |
$100.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$57.55
|
| Rate for Payer: Galaxy Health WC |
$122.30
|
| Rate for Payer: Global Benefits Group Commercial |
$86.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.53
|
| Rate for Payer: Multiplan Commercial |
$115.10
|
| Rate for Payer: Networks By Design Commercial |
$71.94
|
| Rate for Payer: Prime Health Services Commercial |
$122.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.33
|
| Rate for Payer: United Healthcare All Other HMO |
$53.06
|
| Rate for Payer: United Healthcare HMO Rider |
$51.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.48
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
OP
|
$143.88
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
NDG118915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$859.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$859.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.70
|
| Rate for Payer: Blue Distinction Transplant |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$106.04
|
| Rate for Payer: Blue Shield of California EPN |
$130.65
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna of CA HMO |
$100.72
|
| Rate for Payer: Cigna of CA PPO |
$100.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.30
|
| Rate for Payer: Dignity Health Media |
$122.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$57.55
|
| Rate for Payer: Galaxy Health WC |
$122.30
|
| Rate for Payer: Global Benefits Group Commercial |
$86.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.53
|
| Rate for Payer: Multiplan Commercial |
$115.10
|
| Rate for Payer: Networks By Design Commercial |
$71.94
|
| Rate for Payer: Prime Health Services Commercial |
$122.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.94
|
| Rate for Payer: United Healthcare All Other HMO |
$71.94
|
| Rate for Payer: United Healthcare HMO Rider |
$71.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.30
|
| Rate for Payer: Vantage Medical Group Senior |
$122.30
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
OP
|
$94.75
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
1726016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$488.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$488.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.90
|
| Rate for Payer: Blue Distinction Transplant |
$56.85
|
| Rate for Payer: Blue Shield of California Commercial |
$69.83
|
| Rate for Payer: Blue Shield of California EPN |
$85.80
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cigna of CA HMO |
$66.32
|
| Rate for Payer: Cigna of CA PPO |
$66.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.54
|
| Rate for Payer: Dignity Health Media |
$80.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.90
|
| Rate for Payer: Galaxy Health WC |
$80.54
|
| Rate for Payer: Global Benefits Group Commercial |
$56.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.74
|
| Rate for Payer: Multiplan Commercial |
$75.80
|
| Rate for Payer: Networks By Design Commercial |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$80.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.38
|
| Rate for Payer: United Healthcare All Other HMO |
$47.38
|
| Rate for Payer: United Healthcare HMO Rider |
$47.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.54
|
| Rate for Payer: Vantage Medical Group Senior |
$80.54
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
IP
|
$94.75
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
1726016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$80.54 |
| Rate for Payer: Blue Shield of California Commercial |
$67.46
|
| Rate for Payer: Blue Shield of California EPN |
$48.51
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cigna of CA HMO |
$66.32
|
| Rate for Payer: Cigna of CA PPO |
$66.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.90
|
| Rate for Payer: Galaxy Health WC |
$80.54
|
| Rate for Payer: Global Benefits Group Commercial |
$56.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.74
|
| Rate for Payer: Multiplan Commercial |
$75.80
|
| Rate for Payer: Networks By Design Commercial |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$80.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.78
|
| Rate for Payer: United Healthcare All Other HMO |
$34.94
|
| Rate for Payer: United Healthcare HMO Rider |
$34.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.27
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
IP
|
$170.29
|
|
|
Service Code
|
CPT 90371
|
| Hospital Charge Code |
1720099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Blue Shield of California Commercial |
$121.25
|
| Rate for Payer: Blue Shield of California EPN |
$87.19
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cigna of CA HMO |
$119.20
|
| Rate for Payer: Cigna of CA PPO |
$119.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.87
|
| Rate for Payer: Multiplan Commercial |
$136.23
|
| Rate for Payer: Networks By Design Commercial |
$85.14
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.30
|
| Rate for Payer: United Healthcare All Other HMO |
$62.80
|
| Rate for Payer: United Healthcare HMO Rider |
$61.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.20
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
OP
|
$170.29
|
|
|
Service Code
|
CPT 90371
|
| Hospital Charge Code |
1720099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$958.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$958.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.79
|
| Rate for Payer: Blue Distinction Transplant |
$102.17
|
| Rate for Payer: Blue Shield of California Commercial |
$125.50
|
| Rate for Payer: Blue Shield of California EPN |
$162.18
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cigna of CA HMO |
$119.20
|
| Rate for Payer: Cigna of CA PPO |
$119.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.84
|
| Rate for Payer: Dignity Health Media |
$137.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.89
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$127.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$226.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$223.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.78
|
| Rate for Payer: Multiplan Commercial |
$136.23
|
| Rate for Payer: Networks By Design Commercial |
$85.14
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.14
|
| Rate for Payer: United Healthcare All Other HMO |
$85.14
|
| Rate for Payer: United Healthcare HMO Rider |
$85.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.68
|
| Rate for Payer: Vantage Medical Group Senior |
$137.89
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$337.44
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
NDG222472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$1,114.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,114.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$269.63
|
| Rate for Payer: Blue Distinction Transplant |
$202.46
|
| Rate for Payer: Blue Shield of California Commercial |
$248.69
|
| Rate for Payer: Blue Shield of California EPN |
$144.60
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cigna of CA HMO |
$236.21
|
| Rate for Payer: Cigna of CA PPO |
$236.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.82
|
| Rate for Payer: Dignity Health Media |
$286.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.98
|
| Rate for Payer: Galaxy Health WC |
$286.82
|
| Rate for Payer: Global Benefits Group Commercial |
$202.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$253.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.99
|
| Rate for Payer: Multiplan Commercial |
$269.95
|
| Rate for Payer: Networks By Design Commercial |
$168.72
|
| Rate for Payer: Prime Health Services Commercial |
$286.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.72
|
| Rate for Payer: United Healthcare All Other HMO |
$168.72
|
| Rate for Payer: United Healthcare HMO Rider |
$168.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.82
|
| Rate for Payer: Vantage Medical Group Senior |
$286.82
|
|
