|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$337.44
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
NDG222472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$286.82 |
| Rate for Payer: Blue Shield of California Commercial |
$240.26
|
| Rate for Payer: Blue Shield of California EPN |
$172.77
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$225.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.56
|
| 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: United Healthcare All Other Commercial |
$127.42
|
| Rate for Payer: United Healthcare All Other HMO |
$124.45
|
| Rate for Payer: United Healthcare HMO Rider |
$121.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.36
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Blue Shield of California Commercial |
$45.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.70
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO |
$44.70
|
| Rate for Payer: Cigna of CA PPO |
$44.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.54
|
| Rate for Payer: Galaxy Health WC |
$54.28
|
| Rate for Payer: Global Benefits Group Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.33
|
| Rate for Payer: Multiplan Commercial |
$51.09
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$54.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO |
$23.55
|
| Rate for Payer: United Healthcare HMO Rider |
$23.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.07
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$213.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$213.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.02
|
| Rate for Payer: Blue Distinction Transplant |
$38.32
|
| Rate for Payer: Blue Shield of California Commercial |
$47.06
|
| Rate for Payer: Blue Shield of California EPN |
$29.69
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO |
$44.70
|
| Rate for Payer: Cigna of CA PPO |
$44.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.28
|
| Rate for Payer: Dignity Health Media |
$54.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.54
|
| Rate for Payer: Galaxy Health WC |
$54.28
|
| Rate for Payer: Global Benefits Group Commercial |
$38.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.33
|
| Rate for Payer: Multiplan Commercial |
$51.09
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$54.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.93
|
| Rate for Payer: United Healthcare All Other HMO |
$31.93
|
| Rate for Payer: United Healthcare HMO Rider |
$31.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.28
|
| Rate for Payer: Vantage Medical Group Senior |
$54.28
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Blue Shield of California Commercial |
$45.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.70
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO |
$44.70
|
| Rate for Payer: Cigna of CA PPO |
$44.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.54
|
| Rate for Payer: Galaxy Health WC |
$54.28
|
| Rate for Payer: Global Benefits Group Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.33
|
| Rate for Payer: Multiplan Commercial |
$51.09
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$54.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO |
$23.55
|
| Rate for Payer: United Healthcare HMO Rider |
$23.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.07
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$213.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$213.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.02
|
| Rate for Payer: Blue Distinction Transplant |
$38.32
|
| Rate for Payer: Blue Shield of California Commercial |
$47.06
|
| Rate for Payer: Blue Shield of California EPN |
$29.69
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO |
$44.70
|
| Rate for Payer: Cigna of CA PPO |
$44.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.28
|
| Rate for Payer: Dignity Health Media |
$54.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.54
|
| Rate for Payer: Galaxy Health WC |
$54.28
|
| Rate for Payer: Global Benefits Group Commercial |
$38.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.33
|
| Rate for Payer: Multiplan Commercial |
$51.09
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$54.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.93
|
| Rate for Payer: United Healthcare All Other HMO |
$31.93
|
| Rate for Payer: United Healthcare HMO Rider |
$31.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.28
|
| Rate for Payer: Vantage Medical Group Senior |
$54.28
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$76.98
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
NDG119731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$213.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$213.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.02
|
| Rate for Payer: Blue Distinction Transplant |
$46.19
|
| Rate for Payer: Blue Shield of California Commercial |
$56.73
|
| Rate for Payer: Blue Shield of California EPN |
$29.69
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna of CA HMO |
$53.89
|
| Rate for Payer: Cigna of CA PPO |
$53.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.43
|
| Rate for Payer: Dignity Health Media |
$65.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.79
|
| Rate for Payer: Galaxy Health WC |
$65.43
|
| Rate for Payer: Global Benefits Group Commercial |
$46.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.58
|
| Rate for Payer: Networks By Design Commercial |
$38.49
|
| Rate for Payer: Prime Health Services Commercial |
$65.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.49
|
| Rate for Payer: United Healthcare All Other HMO |
$38.49
|
| Rate for Payer: United Healthcare HMO Rider |
$38.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.43
|
| Rate for Payer: Vantage Medical Group Senior |
$65.43
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$76.98
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
NDG119731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$65.43 |
| Rate for Payer: Blue Shield of California Commercial |
$54.81
|
| Rate for Payer: Blue Shield of California EPN |
$39.41
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna of CA HMO |
$53.89
|
| Rate for Payer: Cigna of CA PPO |
$53.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.79
|
| Rate for Payer: Galaxy Health WC |
$65.43
|
| Rate for Payer: Global Benefits Group Commercial |
$46.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.58
|
| Rate for Payer: Networks By Design Commercial |
$38.49
|
| Rate for Payer: Prime Health Services Commercial |
$65.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.07
|
| Rate for Payer: United Healthcare All Other HMO |
$28.39
|
| Rate for Payer: United Healthcare HMO Rider |
$27.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.40
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$79.32
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
1720633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Blue Shield of California Commercial |
$56.48
|
| Rate for Payer: Blue Shield of California EPN |
$40.61
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna of CA HMO |
$55.52
|
| Rate for Payer: Cigna of CA PPO |
$55.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.73
|
| Rate for Payer: Galaxy Health WC |
$67.42
|
| Rate for Payer: Global Benefits Group Commercial |
$47.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.04
|
| Rate for Payer: Multiplan Commercial |
$63.46
|
| Rate for Payer: Networks By Design Commercial |
$39.66
|
| Rate for Payer: Prime Health Services Commercial |
$67.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.95
|
| Rate for Payer: United Healthcare All Other HMO |
$29.25
|
| Rate for Payer: United Healthcare HMO Rider |
$28.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.18
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$79.32
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
1720633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$489.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$489.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.86
|
| Rate for Payer: Blue Distinction Transplant |
$47.59
|
| Rate for Payer: Blue Shield of California Commercial |
$58.46
|
| Rate for Payer: Blue Shield of California EPN |
$72.94
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna of CA HMO |
$55.52
|
| Rate for Payer: Cigna of CA PPO |
$55.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.42
|
| Rate for Payer: Dignity Health Media |
$67.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.73
|
| Rate for Payer: Galaxy Health WC |
$67.42
|
| Rate for Payer: Global Benefits Group Commercial |
$47.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.04
|
| Rate for Payer: Multiplan Commercial |
$63.46
|
| Rate for Payer: Networks By Design Commercial |
$39.66
|
| Rate for Payer: Prime Health Services Commercial |
$67.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.66
|
| Rate for Payer: United Healthcare All Other HMO |
$39.66
|
| Rate for Payer: United Healthcare HMO Rider |
$39.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.42
|
| Rate for Payer: Vantage Medical Group Senior |
$67.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$210.43
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
1722054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$1,057.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.53
|
| Rate for Payer: Blue Distinction Transplant |
$126.26
|
| Rate for Payer: Blue Shield of California Commercial |
$155.09
|
| Rate for Payer: Blue Shield of California EPN |
$199.10
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna of CA HMO |
$147.30
|
| Rate for Payer: Cigna of CA PPO |
$147.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.87
|
| Rate for Payer: Dignity Health Media |
$178.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.17
|
| Rate for Payer: Galaxy Health WC |
$178.87
|
| Rate for Payer: Global Benefits Group Commercial |
$126.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Multiplan Commercial |
$168.34
|
| Rate for Payer: Networks By Design Commercial |
$105.22
|
| Rate for Payer: Prime Health Services Commercial |
$178.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.22
|
| Rate for Payer: United Healthcare All Other HMO |
$105.22
|
| Rate for Payer: United Healthcare HMO Rider |
$105.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.87
|
| Rate for Payer: Vantage Medical Group Senior |
$178.87
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$210.43
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
1722054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$178.87 |
| Rate for Payer: Blue Shield of California Commercial |
$149.83
|
| Rate for Payer: Blue Shield of California EPN |
$107.74
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna of CA HMO |
$147.30
|
| Rate for Payer: Cigna of CA PPO |
$147.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.17
|
| Rate for Payer: Galaxy Health WC |
$178.87
|
| Rate for Payer: Global Benefits Group Commercial |
$126.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Multiplan Commercial |
$168.34
|
| Rate for Payer: Networks By Design Commercial |
$105.22
|
| Rate for Payer: Prime Health Services Commercial |
$178.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.46
|
| Rate for Payer: United Healthcare All Other HMO |
$77.61
|
| Rate for Payer: United Healthcare HMO Rider |
$75.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.44
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$213.32
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
1721119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$181.32 |
| Rate for Payer: Blue Shield of California Commercial |
$151.88
|
| Rate for Payer: Blue Shield of California EPN |
$109.22
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cigna of CA HMO |
$149.32
|
| Rate for Payer: Cigna of CA PPO |
$149.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.33
|
| Rate for Payer: Galaxy Health WC |
$181.32
|
| Rate for Payer: Global Benefits Group Commercial |
$127.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$170.66
|
| Rate for Payer: Networks By Design Commercial |
$106.66
|
| Rate for Payer: Prime Health Services Commercial |
$181.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.55
|
| Rate for Payer: United Healthcare All Other HMO |
$78.67
|
| Rate for Payer: United Healthcare HMO Rider |
$76.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.40
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$213.32
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
1721119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$663.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$663.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.79
|
| Rate for Payer: Blue Distinction Transplant |
$127.99
|
| Rate for Payer: Blue Shield of California Commercial |
$157.22
|
| Rate for Payer: Blue Shield of California EPN |
$98.75
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cigna of CA HMO |
$149.32
|
| Rate for Payer: Cigna of CA PPO |
$149.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.32
|
| Rate for Payer: Dignity Health Media |
$181.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.33
|
| Rate for Payer: Galaxy Health WC |
$181.32
|
| Rate for Payer: Global Benefits Group Commercial |
$127.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$170.66
|
| Rate for Payer: Networks By Design Commercial |
$106.66
|
| Rate for Payer: Prime Health Services Commercial |
$181.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.66
|
| Rate for Payer: United Healthcare All Other HMO |
$106.66
|
| Rate for Payer: United Healthcare HMO Rider |
$106.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.32
|
| Rate for Payer: Vantage Medical Group Senior |
$181.32
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$18,614.24
|
|
|
Service Code
|
APR-DRG 2271
|
| Min. Negotiated Rate |
$14,279.08 |
| Max. Negotiated Rate |
$18,614.24 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,279.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,614.24
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$59,951.82
|
|
|
Service Code
|
APR-DRG 2274
|
| Min. Negotiated Rate |
$45,989.36 |
| Max. Negotiated Rate |
$59,951.82 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45,989.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59,951.82
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$32,910.09
|
|
|
Service Code
|
APR-DRG 2273
|
| Min. Negotiated Rate |
$25,245.50 |
| Max. Negotiated Rate |
$32,910.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,245.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32,910.09
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$23,285.53
|
|
|
Service Code
|
APR-DRG 2272
|
| Min. Negotiated Rate |
$17,862.45 |
| Max. Negotiated Rate |
$23,285.53 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,862.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,285.53
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0264-1965-10
|
| Hospital Charge Code |
1771089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0264-1965-10
|
| Hospital Charge Code |
1771089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$33,504.20
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$25,701.25 |
| Max. Negotiated Rate |
$33,504.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,701.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,504.20
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$48,422.54
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$37,145.19 |
| Max. Negotiated Rate |
$48,422.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,145.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,422.54
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$22,122.14
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$16,970.01 |
| Max. Negotiated Rate |
$22,122.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,970.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,122.14
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$26,094.70
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$20,017.38 |
| Max. Negotiated Rate |
$26,094.70 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,017.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,094.70
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$10,807.47
|
|
|
Service Code
|
APR-DRG 8921
|
| Min. Negotiated Rate |
$8,290.46 |
| Max. Negotiated Rate |
$10,807.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,290.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.47
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$11,481.38
|
|
|
Service Code
|
APR-DRG 8922
|
| Min. Negotiated Rate |
$8,807.42 |
| Max. Negotiated Rate |
$11,481.38 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,807.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,481.38
|
|
