|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
OP
|
$102.48
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$210.28 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.28
|
| 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 |
$56.36
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.11
|
| Rate for Payer: Dignity Health Senior |
$87.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.45
|
| Rate for Payer: Heritage Provider Network Senior |
$47.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.74
|
| Rate for Payer: Multiplan Commercial |
$76.86
|
| Rate for Payer: TriValley Medical Group Commercial |
$40.99
|
| Rate for Payer: TriValley Medical Group Senior |
$40.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.11
|
| Rate for Payer: Vantage Medical Group Senior |
$87.11
|
|
|
HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [118741]
|
Facility
|
IP
|
$102.48
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$76.86 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Cash Price |
$56.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.45
|
| Rate for Payer: Heritage Provider Network Senior |
$47.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.62
|
| Rate for Payer: Multiplan Commercial |
$76.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.93
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
IP
|
$189.69
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$142.27 |
| Rate for Payer: Adventist Health Commercial |
$37.94
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.83
|
| Rate for Payer: Heritage Provider Network Senior |
$87.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$62.81
|
|
|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]
|
Facility
|
OP
|
$189.69
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$409.41 |
| Rate for Payer: Adventist Health Commercial |
$37.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$409.41
|
| 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 |
$104.33
|
| Rate for Payer: Cash Price |
$104.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Senior |
$143.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$130.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.83
|
| Rate for Payer: Heritage Provider Network Senior |
$87.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.88
|
| Rate for Payer: TriValley Medical Group Senior |
$75.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$62.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$143.73
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$373.80
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$280.35 |
| Rate for Payer: Adventist Health Commercial |
$74.76
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.07
|
| Rate for Payer: Heritage Provider Network Senior |
$173.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.45
|
| Rate for Payer: Multiplan Commercial |
$280.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.77
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$373.80
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$403.39 |
| Rate for Payer: Adventist Health Commercial |
$74.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$199.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$256.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.39
|
| 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 |
$205.59
|
| Rate for Payer: Cash Price |
$205.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$171.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.73
|
| Rate for Payer: Dignity Health Senior |
$317.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.07
|
| Rate for Payer: Heritage Provider Network Senior |
$173.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.66
|
| Rate for Payer: Multiplan Commercial |
$280.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$149.52
|
| Rate for Payer: TriValley Medical Group Senior |
$149.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.73
|
| Rate for Payer: Vantage Medical Group Senior |
$317.73
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$71.96 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.96
|
| 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 |
$37.62
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.14
|
| Rate for Payer: Dignity Health Senior |
$58.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.67
|
| Rate for Payer: Heritage Provider Network Senior |
$31.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.88
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.36
|
| Rate for Payer: TriValley Medical Group Senior |
$27.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.14
|
| Rate for Payer: Vantage Medical Group Senior |
$58.14
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.67
|
| Rate for Payer: Heritage Provider Network Senior |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.65
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$71.96 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$36.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.96
|
| 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 |
$37.62
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.14
|
| Rate for Payer: Dignity Health Senior |
$58.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.67
|
| Rate for Payer: Heritage Provider Network Senior |
$31.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.88
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.36
|
| Rate for Payer: TriValley Medical Group Senior |
$27.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.14
|
| Rate for Payer: Vantage Medical Group Senior |
$58.14
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$68.40
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$13.68
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.67
|
| Rate for Payer: Heritage Provider Network Senior |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$51.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.65
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$81.67
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$71.96 |
| Rate for Payer: Adventist Health Commercial |
$16.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.96
|
| 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 |
$44.92
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.42
|
| Rate for Payer: Dignity Health Senior |
$69.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.81
|
| Rate for Payer: Heritage Provider Network Senior |
$37.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.17
|
| Rate for Payer: Multiplan Commercial |
$61.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$32.67
|
| Rate for Payer: TriValley Medical Group Senior |
$32.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.42
|
| Rate for Payer: Vantage Medical Group Senior |
$69.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$81.67
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$61.25 |
| Rate for Payer: Adventist Health Commercial |
$16.33
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.81
|
| Rate for Payer: Heritage Provider Network Senior |
$37.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$61.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.04
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$85.79
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$177.89 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.89
|
| 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 |
$47.18
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.92
|
| Rate for Payer: Dignity Health Senior |
$72.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.72
|
| Rate for Payer: Heritage Provider Network Senior |
$39.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.05
|
| Rate for Payer: Multiplan Commercial |
$64.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.32
|
| Rate for Payer: TriValley Medical Group Senior |
$34.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.92
|
| Rate for Payer: Vantage Medical Group Senior |
$72.92
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$85.79
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$64.34 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.72
|
| Rate for Payer: Heritage Provider Network Senior |
$39.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.45
|
| Rate for Payer: Multiplan Commercial |
$64.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.41
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Adventist Health Commercial |
$44.65
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.36
|
| Rate for Payer: Heritage Provider Network Senior |
$103.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Multiplan Commercial |
$167.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.92
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$223.25
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$483.46 |
| Rate for Payer: Adventist Health Commercial |
$44.65
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.46
|
| 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 |
$122.79
|
| Rate for Payer: Cash Price |
$122.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.76
|
| Rate for Payer: Dignity Health Senior |
$189.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.36
|
| Rate for Payer: Heritage Provider Network Senior |
$103.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$106.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.28
|
| Rate for Payer: Multiplan Commercial |
$167.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$89.30
|
| Rate for Payer: TriValley Medical Group Senior |
$89.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.76
|
| Rate for Payer: Vantage Medical Group Senior |
$189.76
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$239.69
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$179.77 |
| Rate for Payer: Adventist Health Commercial |
$47.94
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.98
|
| Rate for Payer: Heritage Provider Network Senior |
$110.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.92
|
| Rate for Payer: Multiplan Commercial |
$179.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.36
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$239.69
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$266.74 |
| Rate for Payer: Adventist Health Commercial |
$47.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.74
|
| 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 |
$131.83
|
| Rate for Payer: Cash Price |
$131.83
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.74
|
| Rate for Payer: Dignity Health Senior |
$203.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.98
|
| Rate for Payer: Heritage Provider Network Senior |
$110.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.78
|
| Rate for Payer: Multiplan Commercial |
$179.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$95.88
|
| Rate for Payer: TriValley Medical Group Senior |
$95.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$86.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$79.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$203.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.74
|
| Rate for Payer: Vantage Medical Group Senior |
$203.74
|
|
|
Hip Implant (must be billed with Hip Surgery ICD-10-PCS)
|
Facility
|
IP
|
$7,663.00
|
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,663.00 |
| Max. Negotiated Rate |
$7,663.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,663.00
|
|
|
Hip Implant (must be billed with Hip Surgery ICD-10-PCS)
|
Facility
|
IP
|
$7,663.00
|
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,663.00 |
| Max. Negotiated Rate |
$7,663.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,663.00
|
|
|
Hip Implant (must be billed with Hip Surgery ICD-10-PCS)
|
Facility
|
IP
|
$7,663.00
|
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,663.00 |
| Max. Negotiated Rate |
$7,663.00 |
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,663.00
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
IP
|
$736.46
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.30 |
| Max. Negotiated Rate |
$552.35 |
| Rate for Payer: Adventist Health Commercial |
$147.29
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.98
|
| Rate for Payer: Heritage Provider Network Senior |
$340.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.12
|
| Rate for Payer: Multiplan Commercial |
$552.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.84
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [208396]
|
Facility
|
OP
|
$736.46
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.30 |
| Max. Negotiated Rate |
$796.37 |
| Rate for Payer: Adventist Health Commercial |
$147.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$393.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$505.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$796.37
|
| Rate for Payer: Blue Shield of California Commercial |
$313.63
|
| Rate for Payer: Blue Shield of California EPN |
$313.63
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cash Price |
$405.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$625.99
|
| Rate for Payer: Dignity Health Senior |
$625.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.98
|
| Rate for Payer: Heritage Provider Network Senior |
$340.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$504.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.52
|
| Rate for Payer: Multiplan Commercial |
$552.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$294.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$625.99
|
| Rate for Payer: Vantage Medical Group Senior |
$625.99
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.04
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.35
|
| Rate for Payer: Dignity Health Senior |
$2.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2.35
|
|
|
HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION [205938]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.90
|
| Rate for Payer: Multiplan Commercial |
$2.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1.19
|
|
