|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
IP
|
$102.48
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$92.23 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Blue Shield of California Commercial |
$79.22
|
| Rate for Payer: Blue Shield of California EPN |
$51.65
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Central Health Plan Commercial |
$81.98
|
| Rate for Payer: Cigna of CA HMO |
$71.74
|
| Rate for Payer: Cigna of CA PPO |
$71.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.99
|
| Rate for Payer: EPIC Health Plan Senior |
$40.99
|
| Rate for Payer: Galaxy Health WC |
$87.11
|
| Rate for Payer: Global Benefits Group Commercial |
$61.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$76.86
|
| Rate for Payer: Networks By Design Commercial |
$51.24
|
| Rate for Payer: Prime Health Services Commercial |
$87.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.46
|
| Rate for Payer: United Healthcare All Other HMO |
$37.44
|
| Rate for Payer: United Healthcare HMO Rider |
$36.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.56
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
OP
|
$189.69
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$347.61 |
| Rate for Payer: Adventist Health Commercial |
$37.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$347.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.68
|
| 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 |
$104.33
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Central Health Plan Commercial |
$151.75
|
| Rate for Payer: Cigna of CA HMO |
$132.78
|
| Rate for Payer: Cigna of CA PPO |
$132.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.66
|
| Rate for Payer: Galaxy Health WC |
$161.24
|
| Rate for Payer: Global Benefits Group Commercial |
$113.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: InnovAge PACE Commercial |
$196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.09
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Networks By Design Commercial |
$94.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$161.24
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.19
|
| Rate for Payer: United Healthcare All Other HMO |
$69.29
|
| Rate for Payer: United Healthcare HMO Rider |
$67.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$143.73
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
IP
|
$189.69
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$170.72 |
| Rate for Payer: Adventist Health Commercial |
$37.94
|
| Rate for Payer: Blue Shield of California Commercial |
$146.63
|
| Rate for Payer: Blue Shield of California EPN |
$95.60
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Central Health Plan Commercial |
$151.75
|
| Rate for Payer: Cigna of CA HMO |
$132.78
|
| Rate for Payer: Cigna of CA PPO |
$132.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.88
|
| Rate for Payer: Galaxy Health WC |
$161.24
|
| Rate for Payer: Global Benefits Group Commercial |
$113.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.94
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Networks By Design Commercial |
$94.84
|
| Rate for Payer: Prime Health Services Commercial |
$161.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.19
|
| Rate for Payer: United Healthcare All Other HMO |
$69.29
|
| Rate for Payer: United Healthcare HMO Rider |
$67.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.12
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$373.80
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$336.42 |
| Rate for Payer: Adventist Health Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California Commercial |
$288.95
|
| Rate for Payer: Blue Shield of California EPN |
$188.40
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Central Health Plan Commercial |
$299.04
|
| Rate for Payer: Cigna of CA HMO |
$261.66
|
| Rate for Payer: Cigna of CA PPO |
$261.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.52
|
| Rate for Payer: EPIC Health Plan Senior |
$149.52
|
| Rate for Payer: Galaxy Health WC |
$317.73
|
| Rate for Payer: Global Benefits Group Commercial |
$224.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.76
|
| Rate for Payer: Multiplan Commercial |
$280.35
|
| Rate for Payer: Networks By Design Commercial |
$186.90
|
| Rate for Payer: Prime Health Services Commercial |
$317.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.29
|
| Rate for Payer: United Healthcare All Other HMO |
$136.55
|
| Rate for Payer: United Healthcare HMO Rider |
$133.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.42
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$373.80
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$342.49 |
| Rate for Payer: Adventist Health Commercial |
$74.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$342.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.11
|
| 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 |
$205.59
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Central Health Plan Commercial |
$299.04
|
| Rate for Payer: Cigna of CA HMO |
$261.66
|
| Rate for Payer: Cigna of CA PPO |
$261.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.52
|
| Rate for Payer: EPIC Health Plan Senior |
$149.52
|
| Rate for Payer: Galaxy Health WC |
$317.73
|
| Rate for Payer: Global Benefits Group Commercial |
$224.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$177.56
|
| Rate for Payer: InnovAge PACE Commercial |
$186.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.66
|
| Rate for Payer: Multiplan Commercial |
$280.35
|
| Rate for Payer: Networks By Design Commercial |
$186.90
|
| Rate for Payer: Prime Health Services Commercial |
$317.73
|
| Rate for Payer: Riverside University Health System MISP |
$149.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.29
|
| Rate for Payer: United Healthcare All Other HMO |
$136.55
|
| Rate for Payer: United Healthcare HMO Rider |
$133.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.73
|
| Rate for Payer: Vantage Medical Group Senior |
$317.73
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Blue Shield of California Commercial |
$52.87
|
| Rate for Payer: Blue Shield of California EPN |
$34.47
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Central Health Plan Commercial |
$54.72
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$66.94 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.75
|
| 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 |
$37.62
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Central Health Plan Commercial |
$54.72
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.67
|
| Rate for Payer: InnovAge PACE Commercial |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.88
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: Riverside University Health System MISP |
$27.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.14
|
| Rate for Payer: Vantage Medical Group Senior |
$58.14
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Blue Shield of California Commercial |
$52.87
|
| Rate for Payer: Blue Shield of California EPN |
$34.47
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Central Health Plan Commercial |
$54.72
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$66.94 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.75
|
| 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 |
$37.62
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Central Health Plan Commercial |
$54.72
|
| Rate for Payer: Cigna of CA HMO |
$47.88
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.36
|
| Rate for Payer: EPIC Health Plan Senior |
$27.36
|
| Rate for Payer: Galaxy Health WC |
$58.14
|
| Rate for Payer: Global Benefits Group Commercial |
$41.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.67
|
| Rate for Payer: InnovAge PACE Commercial |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.88
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: Networks By Design Commercial |
$34.20
|
| Rate for Payer: Prime Health Services Commercial |
$58.14
|
| Rate for Payer: Riverside University Health System MISP |
$27.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.67
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.14
|
| Rate for Payer: Vantage Medical Group Senior |
$58.14
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$81.67
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$16.33
|
| Rate for Payer: Blue Shield of California Commercial |
$63.13
|
| Rate for Payer: Blue Shield of California EPN |
$41.16
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Central Health Plan Commercial |
$65.34
|
| Rate for Payer: Cigna of CA HMO |
$57.17
|
| Rate for Payer: Cigna of CA PPO |
$57.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.67
|
| Rate for Payer: EPIC Health Plan Senior |
$32.67
|
| Rate for Payer: Galaxy Health WC |
$69.42
|
| Rate for Payer: Global Benefits Group Commercial |
$49.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.33
|
| Rate for Payer: Multiplan Commercial |
$61.25
|
| Rate for Payer: Networks By Design Commercial |
$40.84
|
| Rate for Payer: Prime Health Services Commercial |
$69.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.65
|
| Rate for Payer: United Healthcare All Other HMO |
$29.83
|
| Rate for Payer: United Healthcare HMO Rider |
$29.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.75
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$81.67
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$16.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.75
|
| 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 |
$44.92
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Central Health Plan Commercial |
$65.34
|
| Rate for Payer: Cigna of CA HMO |
$57.17
|
| Rate for Payer: Cigna of CA PPO |
$57.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.67
|
| Rate for Payer: EPIC Health Plan Senior |
$32.67
|
| Rate for Payer: Galaxy Health WC |
$69.42
|
| Rate for Payer: Global Benefits Group Commercial |
$49.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.67
|
| Rate for Payer: InnovAge PACE Commercial |
$40.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.17
|
| Rate for Payer: Multiplan Commercial |
$61.25
|
| Rate for Payer: Networks By Design Commercial |
$40.84
|
| Rate for Payer: Prime Health Services Commercial |
$69.42
|
| Rate for Payer: Riverside University Health System MISP |
$32.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.65
|
| Rate for Payer: United Healthcare All Other HMO |
$29.83
|
| Rate for Payer: United Healthcare HMO Rider |
$29.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.42
|
| Rate for Payer: Vantage Medical Group Senior |
$69.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$85.79
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$151.03 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.35
|
| 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 |
$47.18
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Central Health Plan Commercial |
$68.63
|
| Rate for Payer: Cigna of CA HMO |
$60.05
|
| Rate for Payer: Cigna of CA PPO |
$60.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.92
|
| Rate for Payer: Global Benefits Group Commercial |
$51.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.38
|
| Rate for Payer: InnovAge PACE Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.05
|
| Rate for Payer: Multiplan Commercial |
$64.34
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$72.92
|
| Rate for Payer: Riverside University Health System MISP |
$34.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.20
|
| Rate for Payer: United Healthcare All Other HMO |
$31.34
|
| Rate for Payer: United Healthcare HMO Rider |
$30.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.92
|
| Rate for Payer: Vantage Medical Group Senior |
$72.92
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$85.79
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$77.21 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Blue Shield of California Commercial |
$66.32
|
| Rate for Payer: Blue Shield of California EPN |
$43.24
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Central Health Plan Commercial |
$68.63
|
| Rate for Payer: Cigna of CA HMO |
$60.05
|
| Rate for Payer: Cigna of CA PPO |
$60.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.92
|
| Rate for Payer: Global Benefits Group Commercial |
$51.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$64.34
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$72.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.20
|
| Rate for Payer: United Healthcare All Other HMO |
$31.34
|
| Rate for Payer: United Healthcare HMO Rider |
$30.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.10
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Adventist Health Commercial |
$44.65
|
| Rate for Payer: Blue Shield of California Commercial |
$172.57
|
| Rate for Payer: Blue Shield of California EPN |
$112.52
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Central Health Plan Commercial |
$178.60
|
| Rate for Payer: Cigna of CA HMO |
$156.28
|
| Rate for Payer: Cigna of CA PPO |
$156.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.30
|
| Rate for Payer: EPIC Health Plan Senior |
$89.30
|
| Rate for Payer: Galaxy Health WC |
$189.76
|
| Rate for Payer: Global Benefits Group Commercial |
$133.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.65
|
| Rate for Payer: Multiplan Commercial |
$167.44
|
| Rate for Payer: Networks By Design Commercial |
$111.62
|
| Rate for Payer: Prime Health Services Commercial |
$189.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.79
|
| Rate for Payer: United Healthcare All Other HMO |
$81.55
|
| Rate for Payer: United Healthcare HMO Rider |
$79.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.11
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$223.25
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$410.48 |
| Rate for Payer: Adventist Health Commercial |
$44.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$410.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.98
|
| 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 |
$122.79
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Central Health Plan Commercial |
$178.60
|
| Rate for Payer: Cigna of CA HMO |
$156.28
|
| Rate for Payer: Cigna of CA PPO |
$156.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.30
|
| Rate for Payer: EPIC Health Plan Senior |
$89.30
|
| Rate for Payer: Galaxy Health WC |
$189.76
|
| Rate for Payer: Global Benefits Group Commercial |
$133.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$164.42
|
| Rate for Payer: InnovAge PACE Commercial |
$111.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.28
|
| Rate for Payer: Multiplan Commercial |
$167.44
|
| Rate for Payer: Networks By Design Commercial |
$111.62
|
| Rate for Payer: Prime Health Services Commercial |
$189.76
|
| Rate for Payer: Riverside University Health System MISP |
$89.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.79
|
| Rate for Payer: United Healthcare All Other HMO |
$81.55
|
| Rate for Payer: United Healthcare HMO Rider |
$79.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.76
|
| Rate for Payer: Vantage Medical Group Senior |
$189.76
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$239.69
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$215.72 |
| Rate for Payer: Adventist Health Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$185.28
|
| Rate for Payer: Blue Shield of California EPN |
$120.80
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Central Health Plan Commercial |
$191.75
|
| Rate for Payer: Cigna of CA HMO |
$167.78
|
| Rate for Payer: Cigna of CA PPO |
$167.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.88
|
| Rate for Payer: EPIC Health Plan Senior |
$95.88
|
| Rate for Payer: Galaxy Health WC |
$203.74
|
| Rate for Payer: Global Benefits Group Commercial |
$143.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.94
|
| Rate for Payer: Multiplan Commercial |
$179.77
|
| Rate for Payer: Networks By Design Commercial |
$119.84
|
| Rate for Payer: Prime Health Services Commercial |
$203.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$87.56
|
| Rate for Payer: United Healthcare HMO Rider |
$85.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$239.69
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$226.48 |
| Rate for Payer: Adventist Health Commercial |
$47.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$145.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$226.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.51
|
| Rate for Payer: Blue Shield of California Commercial |
$128.49
|
| Rate for Payer: Blue Shield of California EPN |
$116.81
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Central Health Plan Commercial |
$191.75
|
| Rate for Payer: Cigna of CA HMO |
$167.78
|
| Rate for Payer: Cigna of CA PPO |
$167.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$203.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.88
|
| Rate for Payer: EPIC Health Plan Senior |
$95.88
|
| Rate for Payer: Galaxy Health WC |
$203.74
|
| Rate for Payer: Global Benefits Group Commercial |
$143.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$215.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.45
|
| Rate for Payer: InnovAge PACE Commercial |
$119.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.78
|
| Rate for Payer: Multiplan Commercial |
$179.77
|
| Rate for Payer: Networks By Design Commercial |
$119.84
|
| Rate for Payer: Prime Health Services Commercial |
$203.74
|
| Rate for Payer: Riverside University Health System MISP |
$95.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.96
|
| Rate for Payer: United Healthcare All Other HMO |
$87.56
|
| Rate for Payer: United Healthcare HMO Rider |
$85.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.74
|
| Rate for Payer: Vantage Medical Group Senior |
$203.74
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3.66
|
| Rate for Payer: Blue Shield of California EPN |
$2.39
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Riverside University Health System MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HS OS STRIP BARRIER ELASTIC
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606455
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
OP
|
$736.46
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$676.16 |
| Rate for Payer: Adventist Health Commercial |
$147.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$676.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.51
|
| Rate for Payer: Blue Shield of California Commercial |
$405.88
|
| Rate for Payer: Blue Shield of California EPN |
$368.98
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Central Health Plan Commercial |
$589.17
|
| Rate for Payer: Cigna of CA HMO |
$515.52
|
| Rate for Payer: Cigna of CA PPO |
$515.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$625.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$625.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.58
|
| Rate for Payer: EPIC Health Plan Senior |
$294.58
|
| Rate for Payer: Galaxy Health WC |
$625.99
|
| Rate for Payer: Global Benefits Group Commercial |
$441.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$662.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$535.47
|
| Rate for Payer: InnovAge PACE Commercial |
$368.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.52
|
| Rate for Payer: Multiplan Commercial |
$552.35
|
| Rate for Payer: Networks By Design Commercial |
$368.23
|
| Rate for Payer: Prime Health Services Commercial |
$625.99
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$441.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$441.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.39
|
| Rate for Payer: United Healthcare All Other HMO |
$269.03
|
| Rate for Payer: United Healthcare HMO Rider |
$263.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$625.99
|
| Rate for Payer: Vantage Medical Group Senior |
$625.99
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
IP
|
$736.46
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.29 |
| Max. Negotiated Rate |
$662.81 |
| Rate for Payer: Adventist Health Commercial |
$147.29
|
| Rate for Payer: Blue Shield of California Commercial |
$569.28
|
| Rate for Payer: Blue Shield of California EPN |
$371.18
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Central Health Plan Commercial |
$589.17
|
| Rate for Payer: Cigna of CA HMO |
$515.52
|
| Rate for Payer: Cigna of CA PPO |
$515.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.58
|
| Rate for Payer: EPIC Health Plan Senior |
$294.58
|
| Rate for Payer: Galaxy Health WC |
$625.99
|
| Rate for Payer: Global Benefits Group Commercial |
$441.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$662.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.29
|
| Rate for Payer: Multiplan Commercial |
$552.35
|
| Rate for Payer: Networks By Design Commercial |
$368.23
|
| Rate for Payer: Prime Health Services Commercial |
$625.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.39
|
| Rate for Payer: United Healthcare All Other HMO |
$269.03
|
| Rate for Payer: United Healthcare HMO Rider |
$263.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.19
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Central Health Plan Commercial |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.43
|
| Rate for Payer: EPIC Health Plan Senior |
$1.43
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: Blue Shield of California Commercial |
$3.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.58
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Central Health Plan Commercial |
$2.86
|
| Rate for Payer: Cigna of CA HMO |
$2.51
|
| Rate for Payer: Cigna of CA PPO |
$2.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Senior |
$2.14
|
| Rate for Payer: Galaxy Health WC |
$3.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.14
|
| Rate for Payer: InnovAge PACE Commercial |
$3.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: Networks By Design Commercial |
$1.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.14
|
| Rate for Payer: Prime Health Services Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Medicare |
$2.27
|
| Rate for Payer: Riverside University Health System MISP |
$2.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.91
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.65
|
| Rate for Payer: Cigna of CA PPO |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Senior |
$1.51
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION [239091]
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Adventist Health Commercial |
$0.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California EPN |
$3.78
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Central Health Plan Commercial |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$2.65
|
| Rate for Payer: Cigna of CA PPO |
$2.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.71
|
| Rate for Payer: EPIC Health Plan Senior |
$1.26
|
| Rate for Payer: Galaxy Health WC |
$3.21
|
| Rate for Payer: Global Benefits Group Commercial |
$2.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$2.83
|
| Rate for Payer: Networks By Design Commercial |
$1.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1.26
|
| Rate for Payer: Prime Health Services Commercial |
$3.21
|
| Rate for Payer: Prime Health Services Medicare |
$1.34
|
| Rate for Payer: Riverside University Health System MISP |
$1.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
