|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.90
|
| 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 |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.76
|
| Rate for Payer: TriValley Medical Group Senior |
$5.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.24
|
|
|
HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.27
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.67
|
| Rate for Payer: Heritage Provider Network Senior |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.77
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
OP
|
$168.12
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$224.84 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.84
|
| Rate for Payer: Blue Shield of California Commercial |
$128.47
|
| Rate for Payer: Blue Shield of California EPN |
$128.47
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.84
|
| Rate for Payer: Heritage Provider Network Senior |
$77.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$80.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$117.68
|
| Rate for Payer: Multiplan Commercial |
$126.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.25
|
| Rate for Payer: TriValley Medical Group Senior |
$67.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.90
|
| Rate for Payer: Vantage Medical Group Senior |
$142.90
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [118915]
|
Facility
|
IP
|
$168.12
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$126.09 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.27
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.84
|
| Rate for Payer: Heritage Provider Network Senior |
$77.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.03
|
| Rate for Payer: Multiplan Commercial |
$126.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.66
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
IP
|
$106.58
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$79.94 |
| Rate for Payer: Adventist Health Commercial |
$21.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.64
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.35
|
| Rate for Payer: Heritage Provider Network Senior |
$49.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Multiplan Commercial |
$79.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.29
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
OP
|
$106.58
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$150.01 |
| Rate for Payer: Adventist Health Commercial |
$21.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.01
|
| Rate for Payer: Blue Shield of California Commercial |
$82.82
|
| Rate for Payer: Blue Shield of California EPN |
$82.82
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.35
|
| Rate for Payer: Heritage Provider Network Senior |
$49.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$50.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.61
|
| Rate for Payer: Multiplan Commercial |
$79.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.63
|
| Rate for Payer: TriValley Medical Group Senior |
$42.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.59
|
| Rate for Payer: Vantage Medical Group Senior |
$90.59
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
OP
|
$196.80
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$395.54 |
| Rate for Payer: Adventist Health Commercial |
$39.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.54
|
| Rate for Payer: Blue Shield of California Commercial |
$153.56
|
| Rate for Payer: Blue Shield of California EPN |
$153.56
|
| Rate for Payer: Cash Price |
$88.56
|
| Rate for Payer: Cash Price |
$88.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$136.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.12
|
| Rate for Payer: Heritage Provider Network Senior |
$91.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$136.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.51
|
| Rate for Payer: Multiplan Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$78.72
|
| Rate for Payer: TriValley Medical Group Senior |
$78.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Vantage Medical Group Senior |
$150.65
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
IP
|
$196.80
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Adventist Health Commercial |
$39.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.74
|
| Rate for Payer: Cash Price |
$88.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.12
|
| Rate for Payer: Heritage Provider Network Senior |
$91.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$147.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.16
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$396.23
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: Adventist Health Commercial |
$79.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$336.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.66
|
| Rate for Payer: Blue Shield of California Commercial |
$150.59
|
| Rate for Payer: Blue Shield of California EPN |
$150.59
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$336.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.45
|
| Rate for Payer: Heritage Provider Network Senior |
$183.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$277.36
|
| Rate for Payer: Multiplan Commercial |
$297.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$158.49
|
| Rate for Payer: TriValley Medical Group Senior |
$158.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$336.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.80
|
| Rate for Payer: Vantage Medical Group Senior |
$336.80
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$396.23
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$297.17 |
| Rate for Payer: Adventist Health Commercial |
$79.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$255.17
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.45
|
| Rate for Payer: Heritage Provider Network Senior |
$183.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.06
|
| Rate for Payer: Multiplan Commercial |
$297.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.19
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.34
|
| Rate for Payer: Blue Shield of California EPN |
$28.34
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.62
|
| Rate for Payer: Heritage Provider Network Senior |
$32.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.18
|
| Rate for Payer: TriValley Medical Group Senior |
$28.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.89
|
| Rate for Payer: Vantage Medical Group Senior |
$59.89
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.38
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.62
|
| Rate for Payer: Heritage Provider Network Senior |
$32.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.33
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.38
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.62
|
| Rate for Payer: Heritage Provider Network Senior |
$32.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.33
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.34
|
| Rate for Payer: Blue Shield of California EPN |
$28.34
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.62
|
| Rate for Payer: Heritage Provider Network Senior |
$32.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$33.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$52.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.18
|
| Rate for Payer: TriValley Medical Group Senior |
$28.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.89
|
| Rate for Payer: Vantage Medical Group Senior |
$59.89
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$85.76
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$17.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.34
|
| Rate for Payer: Blue Shield of California EPN |
$28.34
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.71
|
| Rate for Payer: Heritage Provider Network Senior |
$39.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.03
|
| Rate for Payer: Multiplan Commercial |
$64.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.30
|
| Rate for Payer: TriValley Medical Group Senior |
$34.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.90
|
| Rate for Payer: Vantage Medical Group Senior |
$72.90
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$85.76
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Adventist Health Commercial |
$17.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.23
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.71
|
| Rate for Payer: Heritage Provider Network Senior |
$39.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.44
|
| Rate for Payer: Multiplan Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.40
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$89.22
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$129.49 |
| Rate for Payer: Adventist Health Commercial |
$17.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.49
|
| Rate for Payer: Blue Shield of California Commercial |
$70.06
|
| Rate for Payer: Blue Shield of California EPN |
$70.06
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.31
|
| Rate for Payer: Heritage Provider Network Senior |
$41.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.45
|
| Rate for Payer: Multiplan Commercial |
$66.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.69
|
| Rate for Payer: TriValley Medical Group Senior |
$35.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.84
|
| Rate for Payer: Vantage Medical Group Senior |
$75.84
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$89.22
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$66.92 |
| Rate for Payer: Adventist Health Commercial |
$17.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.46
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.31
|
| Rate for Payer: Heritage Provider Network Senior |
$41.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.30
|
| Rate for Payer: Multiplan Commercial |
$66.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.54
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$234.41
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$474.87 |
| Rate for Payer: Adventist Health Commercial |
$46.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$474.87
|
| Rate for Payer: Blue Shield of California Commercial |
$190.40
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.53
|
| Rate for Payer: Heritage Provider Network Senior |
$108.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$111.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.09
|
| Rate for Payer: Multiplan Commercial |
$175.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$93.76
|
| Rate for Payer: TriValley Medical Group Senior |
$93.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.25
|
| Rate for Payer: Vantage Medical Group Senior |
$199.25
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$234.41
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$175.81 |
| Rate for Payer: Adventist Health Commercial |
$46.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.96
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.53
|
| Rate for Payer: Heritage Provider Network Senior |
$108.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.60
|
| Rate for Payer: Multiplan Commercial |
$175.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$77.61
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$27,381.71
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$20,434.11 |
| Max. Negotiated Rate |
$27,381.71 |
| Rate for Payer: EPIC Health Plan Medicare |
$20,434.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,434.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,499.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,381.71
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$53,019.22
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$39,566.58 |
| Max. Negotiated Rate |
$53,019.22 |
| Rate for Payer: EPIC Health Plan Medicare |
$39,566.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,566.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,501.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53,019.22
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,191.57
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$16,560.87 |
| Max. Negotiated Rate |
$22,191.57 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,560.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,560.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,045.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,191.57
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$257.90
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$193.43 |
| Rate for Payer: Adventist Health Commercial |
$51.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.09
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.41
|
| Rate for Payer: Heritage Provider Network Senior |
$119.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.47
|
| Rate for Payer: Multiplan Commercial |
$193.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.39
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$257.90
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$219.22 |
| Rate for Payer: Adventist Health Commercial |
$51.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.99
|
| Rate for Payer: Blue Shield of California Commercial |
$99.29
|
| Rate for Payer: Blue Shield of California EPN |
$99.29
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.41
|
| Rate for Payer: Heritage Provider Network Senior |
$119.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$123.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.53
|
| Rate for Payer: Multiplan Commercial |
$193.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$103.16
|
| Rate for Payer: TriValley Medical Group Senior |
$103.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$93.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.22
|
| Rate for Payer: Vantage Medical Group Senior |
$219.22
|
|
