|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California Commercial |
$11.55
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Central Health Plan Commercial |
$11.52
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$10.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$5.76
|
| Rate for Payer: Galaxy Health WC |
$12.24
|
| Rate for Payer: Global Benefits Group Commercial |
$8.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5.26
|
| Rate for Payer: United Healthcare HMO Rider |
$5.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$17,521.44
|
|
|
Service Code
|
APR-DRG 2793
|
| Min. Negotiated Rate |
$11,066.17 |
| Max. Negotiated Rate |
$17,521.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,066.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,187.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,521.44
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$33,786.03
|
|
|
Service Code
|
APR-DRG 2794
|
| Min. Negotiated Rate |
$21,338.54 |
| Max. Negotiated Rate |
$33,786.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,338.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,428.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,786.03
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$7,962.10
|
|
|
Service Code
|
APR-DRG 2791
|
| Min. Negotiated Rate |
$5,028.70 |
| Max. Negotiated Rate |
$7,962.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,028.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,992.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,962.10
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$10,967.26
|
|
|
Service Code
|
APR-DRG 2792
|
| Min. Negotiated Rate |
$6,926.69 |
| Max. Negotiated Rate |
$10,967.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,926.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,254.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,967.26
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
IP
|
$168.12
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$151.31 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Blue Shield of California Commercial |
$134.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.73
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Central Health Plan Commercial |
$134.50
|
| Rate for Payer: Cigna of CA HMO |
$117.68
|
| Rate for Payer: Cigna of CA PPO |
$117.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.25
|
| Rate for Payer: EPIC Health Plan Senior |
$67.25
|
| Rate for Payer: Galaxy Health WC |
$142.90
|
| Rate for Payer: Global Benefits Group Commercial |
$100.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Multiplan Commercial |
$126.09
|
| Rate for Payer: Networks By Design Commercial |
$84.06
|
| Rate for Payer: Prime Health Services Commercial |
$142.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.10
|
| Rate for Payer: United Healthcare All Other HMO |
$61.41
|
| Rate for Payer: United Healthcare HMO Rider |
$60.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.06
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
OP
|
$168.12
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$827.28 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$827.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.07
|
| Rate for Payer: Blue Shield of California Commercial |
$166.25
|
| Rate for Payer: Blue Shield of California EPN |
$151.14
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Central Health Plan Commercial |
$134.50
|
| Rate for Payer: Cigna of CA HMO |
$117.68
|
| Rate for Payer: Cigna of CA PPO |
$117.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.25
|
| Rate for Payer: EPIC Health Plan Senior |
$67.25
|
| Rate for Payer: Galaxy Health WC |
$142.90
|
| Rate for Payer: Global Benefits Group Commercial |
$100.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$117.68
|
| Rate for Payer: Multiplan Commercial |
$126.09
|
| Rate for Payer: Networks By Design Commercial |
$84.06
|
| Rate for Payer: Prime Health Services Commercial |
$142.90
|
| Rate for Payer: Riverside University Health System MISP |
$67.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.10
|
| Rate for Payer: United Healthcare All Other HMO |
$61.41
|
| Rate for Payer: United Healthcare HMO Rider |
$60.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.90
|
| Rate for Payer: Vantage Medical Group Senior |
$142.90
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
OP
|
$106.58
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$442.75 |
| Rate for Payer: Adventist Health Commercial |
$21.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.83
|
| Rate for Payer: Blue Shield of California Commercial |
$107.17
|
| Rate for Payer: Blue Shield of California EPN |
$97.43
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Central Health Plan Commercial |
$85.26
|
| Rate for Payer: Cigna of CA HMO |
$74.61
|
| Rate for Payer: Cigna of CA PPO |
$74.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.63
|
| Rate for Payer: EPIC Health Plan Senior |
$42.63
|
| Rate for Payer: Galaxy Health WC |
$90.59
|
| Rate for Payer: Global Benefits Group Commercial |
$63.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.61
|
| Rate for Payer: Multiplan Commercial |
$79.94
|
| Rate for Payer: Networks By Design Commercial |
$53.29
|
| Rate for Payer: Prime Health Services Commercial |
$90.59
|
| Rate for Payer: Riverside University Health System MISP |
$42.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.93
|
| Rate for Payer: United Healthcare HMO Rider |
$38.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.59
|
| Rate for Payer: Vantage Medical Group Senior |
$90.59
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
IP
|
$106.58
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$95.92 |
| Rate for Payer: Adventist Health Commercial |
$21.32
|
| Rate for Payer: Blue Shield of California Commercial |
$85.48
|
| Rate for Payer: Blue Shield of California EPN |
$53.72
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Central Health Plan Commercial |
$85.26
|
| Rate for Payer: Cigna of CA HMO |
$74.61
|
| Rate for Payer: Cigna of CA PPO |
$74.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.63
|
| Rate for Payer: EPIC Health Plan Senior |
$42.63
|
| Rate for Payer: Galaxy Health WC |
$90.59
|
| Rate for Payer: Global Benefits Group Commercial |
$63.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$79.94
|
| Rate for Payer: Networks By Design Commercial |
$53.29
|
| Rate for Payer: Prime Health Services Commercial |
$90.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.93
|
| Rate for Payer: United Healthcare HMO Rider |
$38.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.90
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
IP
|
$196.80
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$177.12 |
| Rate for Payer: Adventist Health Commercial |
$39.36
|
| Rate for Payer: Blue Shield of California Commercial |
$157.83
|
| Rate for Payer: Blue Shield of California EPN |
$99.19
|
| Rate for Payer: Cash Price |
$88.56
|
| Rate for Payer: Central Health Plan Commercial |
$157.44
|
| Rate for Payer: Cigna of CA HMO |
$137.76
|
| Rate for Payer: Cigna of CA PPO |
$137.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.72
|
| Rate for Payer: EPIC Health Plan Senior |
$78.72
|
| Rate for Payer: Galaxy Health WC |
$167.28
|
| Rate for Payer: Global Benefits Group Commercial |
$118.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.36
|
| Rate for Payer: Multiplan Commercial |
$147.60
|
| Rate for Payer: Networks By Design Commercial |
$98.40
|
| Rate for Payer: Prime Health Services Commercial |
$167.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.86
|
| Rate for Payer: United Healthcare All Other HMO |
$71.89
|
| Rate for Payer: United Healthcare HMO Rider |
$70.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.45
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
OP
|
$196.80
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$878.75 |
| Rate for Payer: Adventist Health Commercial |
$39.36
|
| Rate for Payer: Adventist Health Medi-Cal |
$136.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$878.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$322.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.98
|
| Rate for Payer: Blue Shield of California Commercial |
$198.73
|
| Rate for Payer: Blue Shield of California EPN |
$180.66
|
| Rate for Payer: Cash Price |
$88.56
|
| Rate for Payer: Cash Price |
$88.56
|
| Rate for Payer: Central Health Plan Commercial |
$157.44
|
| Rate for Payer: Cigna of CA HMO |
$137.76
|
| Rate for Payer: Cigna of CA PPO |
$137.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.97
|
| Rate for Payer: EPIC Health Plan Senior |
$150.65
|
| Rate for Payer: Galaxy Health WC |
$167.28
|
| Rate for Payer: Global Benefits Group Commercial |
$118.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$136.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.51
|
| Rate for Payer: Multiplan Commercial |
$147.60
|
| Rate for Payer: Networks By Design Commercial |
$98.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$136.95
|
| Rate for Payer: Prime Health Services Commercial |
$167.28
|
| Rate for Payer: Prime Health Services Medicare |
$145.17
|
| Rate for Payer: Riverside University Health System MISP |
$150.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.86
|
| Rate for Payer: United Healthcare All Other HMO |
$71.89
|
| Rate for Payer: United Healthcare HMO Rider |
$70.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$136.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Vantage Medical Group Senior |
$150.65
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$396.23
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$1,089.45 |
| Rate for Payer: Adventist Health Commercial |
$79.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,089.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$336.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$250.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.42
|
| Rate for Payer: Blue Shield of California Commercial |
$194.88
|
| Rate for Payer: Blue Shield of California EPN |
$177.16
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Central Health Plan Commercial |
$316.98
|
| Rate for Payer: Cigna of CA HMO |
$277.36
|
| Rate for Payer: Cigna of CA PPO |
$277.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$336.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$336.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.49
|
| Rate for Payer: EPIC Health Plan Senior |
$158.49
|
| Rate for Payer: Galaxy Health WC |
$336.80
|
| Rate for Payer: Global Benefits Group Commercial |
$237.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$356.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$251.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$277.36
|
| Rate for Payer: Multiplan Commercial |
$297.17
|
| Rate for Payer: Networks By Design Commercial |
$198.12
|
| Rate for Payer: Prime Health Services Commercial |
$336.80
|
| Rate for Payer: Riverside University Health System MISP |
$158.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.71
|
| Rate for Payer: United Healthcare All Other HMO |
$144.74
|
| Rate for Payer: United Healthcare HMO Rider |
$141.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$336.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.80
|
| Rate for Payer: Vantage Medical Group Senior |
$336.80
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$396.23
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$356.61 |
| Rate for Payer: Adventist Health Commercial |
$79.25
|
| Rate for Payer: Blue Shield of California Commercial |
$317.78
|
| Rate for Payer: Blue Shield of California EPN |
$199.70
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Central Health Plan Commercial |
$316.98
|
| Rate for Payer: Cigna of CA HMO |
$277.36
|
| Rate for Payer: Cigna of CA PPO |
$277.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.49
|
| Rate for Payer: EPIC Health Plan Senior |
$158.49
|
| Rate for Payer: Galaxy Health WC |
$336.80
|
| Rate for Payer: Global Benefits Group Commercial |
$237.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$356.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$251.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Multiplan Commercial |
$297.17
|
| Rate for Payer: Networks By Design Commercial |
$198.12
|
| Rate for Payer: Prime Health Services Commercial |
$336.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.71
|
| Rate for Payer: United Healthcare All Other HMO |
$144.74
|
| Rate for Payer: United Healthcare HMO Rider |
$141.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.77
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Blue Shield of California Commercial |
$56.51
|
| Rate for Payer: Blue Shield of California EPN |
$35.51
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Central Health Plan Commercial |
$56.37
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.09
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.71
|
| Rate for Payer: Blue Shield of California Commercial |
$36.67
|
| Rate for Payer: Blue Shield of California EPN |
$33.34
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Central Health Plan Commercial |
$56.37
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: Riverside University Health System MISP |
$28.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.89
|
| Rate for Payer: Vantage Medical Group Senior |
$59.89
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Blue Shield of California Commercial |
$56.51
|
| Rate for Payer: Blue Shield of California EPN |
$35.51
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Central Health Plan Commercial |
$56.37
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.09
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.71
|
| Rate for Payer: Blue Shield of California Commercial |
$36.67
|
| Rate for Payer: Blue Shield of California EPN |
$33.34
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Central Health Plan Commercial |
$56.37
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: Riverside University Health System MISP |
$28.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.89
|
| Rate for Payer: Vantage Medical Group Senior |
$59.89
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$85.76
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Adventist Health Commercial |
$17.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.71
|
| Rate for Payer: Blue Shield of California Commercial |
$36.67
|
| Rate for Payer: Blue Shield of California EPN |
$33.34
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Central Health Plan Commercial |
$68.61
|
| Rate for Payer: Cigna of CA HMO |
$60.03
|
| Rate for Payer: Cigna of CA PPO |
$60.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.30
|
| Rate for Payer: EPIC Health Plan Senior |
$34.30
|
| Rate for Payer: Galaxy Health WC |
$72.90
|
| Rate for Payer: Global Benefits Group Commercial |
$51.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.03
|
| Rate for Payer: Multiplan Commercial |
$64.32
|
| Rate for Payer: Networks By Design Commercial |
$42.88
|
| Rate for Payer: Prime Health Services Commercial |
$72.90
|
| Rate for Payer: Riverside University Health System MISP |
$34.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.19
|
| Rate for Payer: United Healthcare All Other HMO |
$31.33
|
| Rate for Payer: United Healthcare HMO Rider |
$30.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.90
|
| Rate for Payer: Vantage Medical Group Senior |
$72.90
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$85.76
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$77.18 |
| Rate for Payer: Adventist Health Commercial |
$17.15
|
| Rate for Payer: Blue Shield of California Commercial |
$68.78
|
| Rate for Payer: Blue Shield of California EPN |
$43.22
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Central Health Plan Commercial |
$68.61
|
| Rate for Payer: Cigna of CA HMO |
$60.03
|
| Rate for Payer: Cigna of CA PPO |
$60.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.30
|
| Rate for Payer: EPIC Health Plan Senior |
$34.30
|
| Rate for Payer: Galaxy Health WC |
$72.90
|
| Rate for Payer: Global Benefits Group Commercial |
$51.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.15
|
| Rate for Payer: Multiplan Commercial |
$64.32
|
| Rate for Payer: Networks By Design Commercial |
$42.88
|
| Rate for Payer: Prime Health Services Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.19
|
| Rate for Payer: United Healthcare All Other HMO |
$31.33
|
| Rate for Payer: United Healthcare HMO Rider |
$30.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.09
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$89.22
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$80.30 |
| Rate for Payer: Adventist Health Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California Commercial |
$71.55
|
| Rate for Payer: Blue Shield of California EPN |
$44.97
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Central Health Plan Commercial |
$71.38
|
| Rate for Payer: Cigna of CA HMO |
$62.45
|
| Rate for Payer: Cigna of CA PPO |
$62.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.69
|
| Rate for Payer: EPIC Health Plan Senior |
$35.69
|
| Rate for Payer: Galaxy Health WC |
$75.84
|
| Rate for Payer: Global Benefits Group Commercial |
$53.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.84
|
| Rate for Payer: Multiplan Commercial |
$66.92
|
| Rate for Payer: Networks By Design Commercial |
$44.61
|
| Rate for Payer: Prime Health Services Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.48
|
| Rate for Payer: United Healthcare All Other HMO |
$32.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.22
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$89.22
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Adventist Health Commercial |
$17.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$431.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.93
|
| Rate for Payer: Blue Shield of California Commercial |
$90.66
|
| Rate for Payer: Blue Shield of California EPN |
$82.42
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Central Health Plan Commercial |
$71.38
|
| Rate for Payer: Cigna of CA HMO |
$62.45
|
| Rate for Payer: Cigna of CA PPO |
$62.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.69
|
| Rate for Payer: EPIC Health Plan Senior |
$35.69
|
| Rate for Payer: Galaxy Health WC |
$75.84
|
| Rate for Payer: Global Benefits Group Commercial |
$53.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.45
|
| Rate for Payer: Multiplan Commercial |
$66.92
|
| Rate for Payer: Networks By Design Commercial |
$44.61
|
| Rate for Payer: Prime Health Services Commercial |
$75.84
|
| Rate for Payer: Riverside University Health System MISP |
$35.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.48
|
| Rate for Payer: United Healthcare All Other HMO |
$32.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.84
|
| Rate for Payer: Vantage Medical Group Senior |
$75.84
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$234.41
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$210.97 |
| Rate for Payer: Adventist Health Commercial |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$188.00
|
| Rate for Payer: Blue Shield of California EPN |
$118.14
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Central Health Plan Commercial |
$187.53
|
| Rate for Payer: Cigna of CA HMO |
$164.09
|
| Rate for Payer: Cigna of CA PPO |
$164.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.76
|
| Rate for Payer: EPIC Health Plan Senior |
$93.76
|
| Rate for Payer: Galaxy Health WC |
$199.25
|
| Rate for Payer: Global Benefits Group Commercial |
$140.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$175.81
|
| Rate for Payer: Networks By Design Commercial |
$117.20
|
| Rate for Payer: Prime Health Services Commercial |
$199.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.97
|
| Rate for Payer: United Healthcare All Other HMO |
$85.63
|
| Rate for Payer: United Healthcare HMO Rider |
$83.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.77
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$234.41
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$1,008.83 |
| Rate for Payer: Adventist Health Commercial |
$46.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,008.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.80
|
| Rate for Payer: Blue Shield of California Commercial |
$246.40
|
| Rate for Payer: Blue Shield of California EPN |
$224.00
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Central Health Plan Commercial |
$187.53
|
| Rate for Payer: Cigna of CA HMO |
$164.09
|
| Rate for Payer: Cigna of CA PPO |
$164.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.76
|
| Rate for Payer: EPIC Health Plan Senior |
$93.76
|
| Rate for Payer: Galaxy Health WC |
$199.25
|
| Rate for Payer: Global Benefits Group Commercial |
$140.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.09
|
| Rate for Payer: Multiplan Commercial |
$175.81
|
| Rate for Payer: Networks By Design Commercial |
$117.20
|
| Rate for Payer: Prime Health Services Commercial |
$199.25
|
| Rate for Payer: Riverside University Health System MISP |
$93.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.97
|
| Rate for Payer: United Healthcare All Other HMO |
$85.63
|
| Rate for Payer: United Healthcare HMO Rider |
$83.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.25
|
| Rate for Payer: Vantage Medical Group Senior |
$199.25
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$45,729.26
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$45,729.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,729.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,539.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,355.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,027.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27,351.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,865.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,811.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,319.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,865.27
|
| Rate for Payer: Prime Health Services Medicare |
$26,357.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,671.46
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$89,671.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89,671.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57,924.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81,095.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$79,022.61
|
| Rate for Payer: EPIC Health Plan Senior |
$52,681.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47,892.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67,049.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64,175.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47,892.49
|
| Rate for Payer: Prime Health Services Medicare |
$50,766.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
