|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1721146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Senior |
$1.94
|
| Rate for Payer: Dignity Health Senior |
$1.53
|
| Rate for Payer: Dignity Health Senior |
$2.65
|
| Rate for Payer: Dignity Health Senior |
$2.06
|
| Rate for Payer: Dignity Health Senior |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1.44
|
| Rate for Payer: Heritage Provider Network Senior |
$0.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$1.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.25
|
| Rate for Payer: TriValley Medical Group Senior |
$0.91
|
| Rate for Payer: TriValley Medical Group Senior |
$1.25
|
| Rate for Payer: TriValley Medical Group Senior |
$1.23
|
| Rate for Payer: TriValley Medical Group Senior |
$0.72
|
| Rate for Payer: TriValley Medical Group Senior |
$0.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.94
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$2.62
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.29
|
| Rate for Payer: Dignity Health Senior |
$1.29
|
| Rate for Payer: Dignity Health Senior |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.47
|
| Rate for Payer: Heritage Provider Network Senior |
$0.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$0.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.61
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.29
|
| Rate for Payer: Vantage Medical Group Senior |
$1.29
|
| Rate for Payer: Vantage Medical Group Senior |
$0.86
|
|
|
HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [15847]
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1771169
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
|
HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [15847]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1771169
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.43
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 8290306424
|
| Hospital Charge Code |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 6380760005
|
| Hospital Charge Code |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
|
|
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 |
$0.04 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| 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 |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.14
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.20
|
| Rate for Payer: Dignity Health Senior |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Senior |
$0.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Vantage Medical Group Senior |
$0.20
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [117963]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 8290306424
|
| Hospital Charge Code |
1720019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Senior |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
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 |
$1.74 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.60
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.50
|
| Rate for Payer: Heritage Provider Network Senior |
$6.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.21
|
|
|
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 |
$0.43 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.60
|
| 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 |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| 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 |
$4.32
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.16
|
| Rate for Payer: Dignity Health Senior |
$8.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.21
|
| 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 SYRINGE [117969]
|
Facility
|
IP
|
$7.96
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
1720049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.47
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
|
|
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 |
$0.43 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.47
|
| 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 |
$5.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| 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 |
$3.58
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.77
|
| Rate for Payer: Dignity Health Senior |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.99
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.18
|
| Rate for Payer: TriValley Medical Group Senior |
$3.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.66
|
| 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 SUBCUTANEOUS SYRINGE [224551]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
NDG224551
|
|
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 |
$9.89
|
| 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 |
$9.75
|
| Rate for Payer: Heritage Provider Network Senior |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$5.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.81
|
|
|
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 |
$0.43 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Adventist Health Commercial |
$2.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.89
|
| 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 |
$1.52
|
| 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 Senior |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA 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: 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 |
$5.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.81
|
| 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
|
$4,403.41
|
|
|
Service Code
|
APR-DRG 2791
|
| Min. Negotiated Rate |
$4,403.41 |
| Max. Negotiated Rate |
$4,403.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,403.41
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$17,266.42
|
|
|
Service Code
|
APR-DRG 2794
|
| Min. Negotiated Rate |
$17,266.42 |
| Max. Negotiated Rate |
$17,266.42 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,266.42
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$5,404.28
|
|
|
Service Code
|
APR-DRG 2792
|
| Min. Negotiated Rate |
$5,404.28 |
| Max. Negotiated Rate |
$5,404.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,404.28
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$8,270.58
|
|
|
Service Code
|
APR-DRG 2793
|
| Min. Negotiated Rate |
$8,270.58 |
| Max. Negotiated Rate |
$8,270.58 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,270.58
|
|
|
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 |
$26.04 |
| Max. Negotiated Rate |
$300.56 |
| Rate for Payer: Adventist Health Commercial |
$28.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$300.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.85
|
| 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 |
$107.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.22
|
| Rate for Payer: Blue Shield of California Commercial |
$118.87
|
| Rate for Payer: Blue Shield of California EPN |
$118.87
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.30
|
| Rate for Payer: Dignity Health Senior |
$122.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.62
|
| Rate for Payer: Heritage Provider Network Senior |
$66.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.97
|
| Rate for Payer: Multiplan Commercial |
$107.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.55
|
| Rate for Payer: TriValley Medical Group Senior |
$57.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.07
|
| 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 |
$26.04 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Adventist Health Commercial |
$28.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.85
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.41
|
| Rate for Payer: Heritage Provider Network Senior |
$97.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.97
|
| Rate for Payer: Multiplan Commercial |
$107.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.07
|
|
|
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 |
$17.15 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Adventist Health Commercial |
$18.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.09
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.15
|
| Rate for Payer: Heritage Provider Network Senior |
$64.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.69
|
| Rate for Payer: Multiplan Commercial |
$71.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.66
|
|
|
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 |
$17.15 |
| Max. Negotiated Rate |
$170.89 |
| Rate for Payer: Adventist Health Commercial |
$18.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.09
|
| 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 |
$71.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.24
|
| Rate for Payer: Blue Shield of California Commercial |
$78.08
|
| Rate for Payer: Blue Shield of California EPN |
$78.08
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.54
|
| Rate for Payer: Dignity Health Senior |
$80.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.87
|
| Rate for Payer: Heritage Provider Network Senior |
$43.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.69
|
| Rate for Payer: Multiplan Commercial |
$71.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.90
|
| Rate for Payer: TriValley Medical Group Senior |
$37.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.66
|
| 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 |
$30.82 |
| Max. Negotiated Rate |
$348.70 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Aetna of CA Gatekeeper |
$335.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.99
|
| 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 HMO/PPO |
$348.70
|
| Rate for Payer: Blue Shield of California Commercial |
$144.74
|
| Rate for Payer: Blue Shield of California EPN |
$144.74
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.68
|
| Rate for Payer: Dignity Health Senior |
$151.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.84
|
| Rate for Payer: Heritage Provider Network Senior |
$78.84
|
| Rate for Payer: Humana Medicare |
$137.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.74
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$68.12
|
| Rate for Payer: TriValley Medical Group Senior |
$68.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.89
|
| 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 |
$30.82 |
| Max. Negotiated Rate |
$127.72 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.99
|
| Rate for Payer: Cash Price |
$76.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.29
|
| Rate for Payer: Heritage Provider Network Senior |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.57
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56.89
|
|
|
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 |
$61.08 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Adventist Health Commercial |
$67.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.82
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.45
|
| Rate for Payer: Heritage Provider Network Senior |
$228.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.36
|
| Rate for Payer: Multiplan Commercial |
$253.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$123.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.74
|
|
