|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$337.44
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
NDG222472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$389.85 |
| Rate for Payer: Adventist Health Commercial |
$67.49
|
| Rate for Payer: Aetna of CA Gatekeeper |
$389.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.34
|
| Rate for Payer: Blue Shield of California Commercial |
$136.07
|
| Rate for Payer: Blue Shield of California EPN |
$136.07
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cash Price |
$151.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.82
|
| Rate for Payer: Dignity Health Senior |
$286.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.23
|
| Rate for Payer: Heritage Provider Network Senior |
$156.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$162.65
|
| 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: TriValley Medical Group Commercial |
$134.98
|
| Rate for Payer: TriValley Medical Group Senior |
$134.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$123.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.82
|
| Rate for Payer: Vantage Medical Group Senior |
$286.82
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$47.90 |
| Rate for Payer: Adventist Health Commercial |
$12.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.87
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.23
|
| Rate for Payer: Heritage Provider Network Senior |
$43.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.34
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: Adventist Health Commercial |
$12.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.18
|
| Rate for Payer: Blue Shield of California Commercial |
$26.73
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.28
|
| Rate for Payer: Dignity Health Senior |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.57
|
| Rate for Payer: Heritage Provider Network Senior |
$29.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.54
|
| Rate for Payer: TriValley Medical Group Senior |
$25.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.28
|
| Rate for Payer: Vantage Medical Group Senior |
$54.28
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$47.90 |
| Rate for Payer: Adventist Health Commercial |
$12.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.87
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.23
|
| Rate for Payer: Heritage Provider Network Senior |
$43.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.34
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$63.86
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
1720519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: Adventist Health Commercial |
$12.77
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.18
|
| Rate for Payer: Blue Shield of California Commercial |
$26.73
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.28
|
| Rate for Payer: Dignity Health Senior |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.57
|
| Rate for Payer: Heritage Provider Network Senior |
$29.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$47.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.54
|
| Rate for Payer: TriValley Medical Group Senior |
$25.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.28
|
| Rate for Payer: Vantage Medical Group Senior |
$54.28
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$76.98
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
NDG119731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.89
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.12
|
| Rate for Payer: Heritage Provider Network Senior |
$52.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.72
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$76.98
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
NDG119731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.18
|
| Rate for Payer: Blue Shield of California Commercial |
$26.73
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.43
|
| Rate for Payer: Dignity Health Senior |
$65.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.64
|
| Rate for Payer: Heritage Provider Network Senior |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$57.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.79
|
| Rate for Payer: TriValley Medical Group Senior |
$30.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.43
|
| Rate for Payer: Vantage Medical Group Senior |
$65.43
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$79.32
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
1720633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$171.19 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.16
|
| Rate for Payer: Blue Shield of California Commercial |
$62.97
|
| Rate for Payer: Blue Shield of California EPN |
$62.97
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.42
|
| Rate for Payer: Dignity Health Senior |
$67.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.73
|
| Rate for Payer: Heritage Provider Network Senior |
$36.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.83
|
| Rate for Payer: Multiplan Commercial |
$59.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.73
|
| Rate for Payer: TriValley Medical Group Senior |
$31.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.42
|
| Rate for Payer: Vantage Medical Group Senior |
$67.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$79.32
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
1720633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.49
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.70
|
| Rate for Payer: Heritage Provider Network Senior |
$53.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.83
|
| Rate for Payer: Multiplan Commercial |
$59.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.50
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$210.43
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
1722054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$157.82 |
| Rate for Payer: Adventist Health Commercial |
$42.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.57
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.46
|
| Rate for Payer: Heritage Provider Network Senior |
$142.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$157.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.30
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$210.43
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
1722054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$418.63 |
| Rate for Payer: Adventist Health Commercial |
$42.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$370.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.63
|
| Rate for Payer: Blue Shield of California Commercial |
$179.50
|
| Rate for Payer: Blue Shield of California EPN |
$179.50
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.87
|
| Rate for Payer: Dignity Health Senior |
$178.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.43
|
| Rate for Payer: Heritage Provider Network Senior |
$97.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$244.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$157.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.17
|
| Rate for Payer: TriValley Medical Group Senior |
$84.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.87
|
| Rate for Payer: Vantage Medical Group Senior |
$178.87
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$213.32
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
1721119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$232.28 |
| Rate for Payer: Adventist Health Commercial |
$42.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$146.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.16
|
| Rate for Payer: Blue Shield of California Commercial |
$91.21
|
| Rate for Payer: Blue Shield of California EPN |
$91.21
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.32
|
| Rate for Payer: Dignity Health Senior |
$181.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.77
|
| Rate for Payer: Heritage Provider Network Senior |
$98.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.33
|
| Rate for Payer: Multiplan Commercial |
$159.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$85.33
|
| Rate for Payer: TriValley Medical Group Senior |
$85.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$77.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.32
|
| Rate for Payer: Vantage Medical Group Senior |
$181.32
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$213.32
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
1721119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$159.99 |
| Rate for Payer: Adventist Health Commercial |
$42.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$146.55
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.42
|
| Rate for Payer: Heritage Provider Network Senior |
$144.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.33
|
| Rate for Payer: Multiplan Commercial |
$159.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$77.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.27
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$18,462.29
|
|
|
Service Code
|
APR-DRG 2273
|
| Min. Negotiated Rate |
$18,462.29 |
| Max. Negotiated Rate |
$18,462.29 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,462.29
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$10,442.43
|
|
|
Service Code
|
APR-DRG 2271
|
| Min. Negotiated Rate |
$10,442.43 |
| Max. Negotiated Rate |
$10,442.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,442.43
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$33,632.46
|
|
|
Service Code
|
APR-DRG 2274
|
| Min. Negotiated Rate |
$33,632.46 |
| Max. Negotiated Rate |
$33,632.46 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33,632.46
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$13,062.99
|
|
|
Service Code
|
APR-DRG 2272
|
| Min. Negotiated Rate |
$13,062.99 |
| Max. Negotiated Rate |
$13,062.99 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,062.99
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0264-1965-10
|
| Hospital Charge Code |
1771089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: Dignity Health Senior |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.02
|
| Rate for Payer: TriValley Medical Group Senior |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0264-1965-10
|
| Hospital Charge Code |
1771089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Adventist Health Commercial |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.04
|
| Rate for Payer: Heritage Provider Network Senior |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$18,795.57
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$18,795.57 |
| Max. Negotiated Rate |
$18,795.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,795.57
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$14,638.90
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$14,638.90 |
| Max. Negotiated Rate |
$14,638.90 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,638.90
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$12,410.33
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$12,410.33 |
| Max. Negotiated Rate |
$12,410.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,410.33
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$27,164.64
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$27,164.64 |
| Max. Negotiated Rate |
$27,164.64 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,164.64
|
|
|
Hip core decompression
|
Facility
|
OP
|
$3,543.79
|
|
|
Service Code
|
CPT S2325
|
| Min. Negotiated Rate |
$3,543.79 |
| Max. Negotiated Rate |
$3,543.79 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,543.79
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$8,923.22
|
|
|
Service Code
|
APR-DRG 8923
|
| Min. Negotiated Rate |
$8,923.22 |
| Max. Negotiated Rate |
$8,923.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,923.22
|
|
