|
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 |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| 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 |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.19
|
| 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 Management Network EPO/PPO |
$0.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.08
|
| 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 |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.20
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| 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 Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
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 |
$0.23 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| 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 Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Blue Distinction Transplant |
$5.76
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| 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: Central Health Plan Commercial |
$7.68
|
| 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 Management Network EPO/PPO |
$8.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| 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 |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$8.16
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| 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 Medi-Cal |
$8.16
|
| Rate for Payer: Vantage Medical Group Senior |
$8.16
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION [121687]
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG121687
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Blue Shield of California EPN |
$5.13
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.68
|
| 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: Health Management Network EPO/PPO |
$8.64
|
| 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 |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| 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 SYRINGE [117969]
|
Facility
|
OP
|
$7.96
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1720049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| 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 Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Blue Distinction Transplant |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| 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: Central Health Plan Commercial |
$6.37
|
| 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 Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| 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 |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: Networks By Design Commercial |
$3.98
|
| Rate for Payer: Prime Health Services Commercial |
$6.77
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| 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 Medi-Cal |
$6.77
|
| Rate for Payer: Vantage Medical Group Senior |
$6.77
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.37
|
| 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: Health Management Network EPO/PPO |
$7.16
|
| 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 |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| 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 SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG224551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Blue Shield of California Commercial |
$10.80
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| 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: 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 Management Network EPO/PPO |
$12.96
|
| 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 |
$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 |
$5.44
|
| 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 |
$0.23 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.66
|
| 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 Exchange |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Blue Distinction Transplant |
$8.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| 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: 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: 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 Management Network EPO/PPO |
$12.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.23
|
| 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 |
$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: Riverside University Health System MISP |
$5.76
|
| 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 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 |
$4,957.48 |
| Max. Negotiated Rate |
$7,849.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,957.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,907.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,849.34
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$14,742.76
|
|
|
Service Code
|
APR-DRG 2793
|
| Min. Negotiated Rate |
$9,311.22 |
| Max. Negotiated Rate |
$14,742.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,311.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,095.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,742.76
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$30,778.40
|
|
|
Service Code
|
APR-DRG 2794
|
| Min. Negotiated Rate |
$19,438.99 |
| Max. Negotiated Rate |
$30,778.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,438.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,164.80
|
| 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 |
$6,084.28 |
| Max. Negotiated Rate |
$9,633.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,084.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,250.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,633.44
|
|
|
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 |
$28.78 |
| Max. Negotiated Rate |
$758.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$758.19
|
| 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 Exchange |
$183.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.98
|
| Rate for Payer: Blue Distinction Transplant |
$86.33
|
| Rate for Payer: Blue Shield of California Commercial |
$143.72
|
| 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: Central Health Plan Commercial |
$115.10
|
| 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 Management Network EPO/PPO |
$129.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.36
|
| 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 |
$28.78
|
| Rate for Payer: Multiplan Commercial |
$107.91
|
| Rate for Payer: Networks By Design Commercial |
$71.94
|
| Rate for Payer: Prime Health Services Commercial |
$122.30
|
| Rate for Payer: Riverside University Health System MISP |
$57.55
|
| 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 Medi-Cal |
$122.30
|
| Rate for Payer: Vantage Medical Group Senior |
$122.30
|
|
|
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 |
$28.78 |
| Max. Negotiated Rate |
$129.49 |
| Rate for Payer: Blue Shield of California Commercial |
$107.91
|
| Rate for Payer: Blue Shield of California EPN |
$76.83
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Central Health Plan Commercial |
$115.10
|
| 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: Health Management Network EPO/PPO |
$129.49
|
| 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 |
$28.78
|
| Rate for Payer: Multiplan Commercial |
$107.91
|
| 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 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 |
$18.95 |
| Max. Negotiated Rate |
$85.28 |
| Rate for Payer: Blue Shield of California Commercial |
$71.06
|
| Rate for Payer: Blue Shield of California EPN |
$50.60
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Central Health Plan Commercial |
$75.80
|
| 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: Health Management Network EPO/PPO |
$85.28
|
| 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 |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$71.06
|
| 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 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 |
$18.95 |
| Max. Negotiated Rate |
$431.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.09
|
| 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 Exchange |
$122.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.09
|
| Rate for Payer: Blue Distinction Transplant |
$56.85
|
| Rate for Payer: Blue Shield of California Commercial |
$94.38
|
| 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: Central Health Plan Commercial |
$75.80
|
| 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 Management Network EPO/PPO |
$85.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.39
|
| 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 |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$71.06
|
| Rate for Payer: Networks By Design Commercial |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$80.54
|
| Rate for Payer: Riverside University Health System MISP |
$37.90
|
| 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 Medi-Cal |
$80.54
|
| Rate for Payer: Vantage Medical Group Senior |
$80.54
|
|
|
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 |
$34.06 |
| Max. Negotiated Rate |
$846.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$846.05
|
| 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 Exchange |
$322.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.57
|
| Rate for Payer: Blue Distinction Transplant |
$102.17
|
| Rate for Payer: Blue Shield of California Commercial |
$178.40
|
| Rate for Payer: Blue Shield of California EPN |
$162.18
|
| Rate for Payer: Caremore Medicare Advantage |
$137.89
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Central Health Plan Commercial |
$136.23
|
| 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 Management Network EPO/PPO |
$153.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$127.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$226.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.89
|
| Rate for Payer: InnovAge PACE Commercial |
$206.84
|
| 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 |
$34.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.78
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: Networks By Design Commercial |
$85.14
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
| Rate for Payer: Prime Health Services Medicare |
$146.17
|
| Rate for Payer: Riverside University Health System MISP |
$151.68
|
| 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 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 |
$34.06 |
| Max. Negotiated Rate |
$153.26 |
| Rate for Payer: Blue Shield of California Commercial |
$127.72
|
| Rate for Payer: Blue Shield of California EPN |
$90.93
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Central Health Plan Commercial |
$136.23
|
| 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: Health Management Network EPO/PPO |
$153.26
|
| 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 |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| 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 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 |
$67.49 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Blue Shield of California Commercial |
$253.08
|
| Rate for Payer: Blue Shield of California EPN |
$180.19
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Central Health Plan Commercial |
$269.95
|
| 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: Health Management Network EPO/PPO |
$303.70
|
| 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 |
$67.49
|
| Rate for Payer: Multiplan Commercial |
$253.08
|
| 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 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 |
$67.49 |
| Max. Negotiated Rate |
$983.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$983.43
|
| 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 Exchange |
$250.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.11
|
| Rate for Payer: Blue Distinction Transplant |
$202.46
|
| Rate for Payer: Blue Shield of California Commercial |
$159.06
|
| 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: Central Health Plan Commercial |
$269.95
|
| 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 Management Network EPO/PPO |
$303.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$253.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.30
|
| 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 |
$67.49
|
| Rate for Payer: Multiplan Commercial |
$253.08
|
| Rate for Payer: Networks By Design Commercial |
$168.72
|
| Rate for Payer: Prime Health Services Commercial |
$286.82
|
| Rate for Payer: Riverside University Health System MISP |
$134.98
|
| 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 Medi-Cal |
$286.82
|
| Rate for Payer: Vantage Medical Group Senior |
$286.82
|
|
|
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 |
$12.77 |
| Max. Negotiated Rate |
$57.47 |
| Rate for Payer: Blue Shield of California Commercial |
$47.90
|
| Rate for Payer: Blue Shield of California EPN |
$34.10
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Central Health Plan Commercial |
$51.09
|
| 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: Health Management Network EPO/PPO |
$57.47
|
| 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 |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| 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 |
$12.77 |
| Max. Negotiated Rate |
$188.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.80
|
| 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 Exchange |
$56.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.04
|
| Rate for Payer: Blue Distinction Transplant |
$38.32
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| 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: Central Health Plan Commercial |
$51.09
|
| 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 Management Network EPO/PPO |
$57.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.77
|
| 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 |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$54.28
|
| Rate for Payer: Riverside University Health System MISP |
$25.54
|
| 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 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 |
$12.77 |
| Max. Negotiated Rate |
$57.47 |
| Rate for Payer: Blue Shield of California Commercial |
$47.90
|
| Rate for Payer: Blue Shield of California EPN |
$34.10
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Central Health Plan Commercial |
$51.09
|
| 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: Health Management Network EPO/PPO |
$57.47
|
| 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 |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| 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 |
$12.77 |
| Max. Negotiated Rate |
$188.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.80
|
| 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 Exchange |
$56.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.04
|
| Rate for Payer: Blue Distinction Transplant |
$38.32
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| 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: Central Health Plan Commercial |
$51.09
|
| 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 Management Network EPO/PPO |
$57.47
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.77
|
| 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 |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| Rate for Payer: Networks By Design Commercial |
$31.93
|
| Rate for Payer: Prime Health Services Commercial |
$54.28
|
| Rate for Payer: Riverside University Health System MISP |
$25.54
|
| 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 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
|
IP
|
$76.98
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
NDG119731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Blue Shield of California Commercial |
$57.74
|
| Rate for Payer: Blue Shield of California EPN |
$41.11
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Central Health Plan Commercial |
$61.58
|
| 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: Health Management Network EPO/PPO |
$69.28
|
| 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 |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.74
|
| 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) 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 |
$15.40 |
| Max. Negotiated Rate |
$188.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.80
|
| 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 Exchange |
$56.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.04
|
| Rate for Payer: Blue Distinction Transplant |
$46.19
|
| Rate for Payer: Blue Shield of California Commercial |
$32.66
|
| 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: Central Health Plan Commercial |
$61.58
|
| 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 Management Network EPO/PPO |
$69.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.77
|
| 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 |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.74
|
| Rate for Payer: Networks By Design Commercial |
$38.49
|
| Rate for Payer: Prime Health Services Commercial |
$65.43
|
| Rate for Payer: Riverside University Health System MISP |
$30.79
|
| 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 Medi-Cal |
$65.43
|
| Rate for Payer: Vantage Medical Group Senior |
$65.43
|
|
