|
HC ADMINISTRATION OF XOFIGO
|
Facility
IP
|
$3,258.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$781.92 |
| Max. Negotiated Rate |
$2,769.30 |
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,303.20
|
| Rate for Payer: Galaxy Health WC |
$2,769.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,954.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,173.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,241.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.92
|
| Rate for Payer: Multiplan Commercial |
$2,606.40
|
| Rate for Payer: Networks By Design Commercial |
$2,117.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,769.30
|
|
|
HC ADMIN SOTROVIMAB INFUSION MA
|
Facility
OP
|
$855.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
949001325
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$3,128.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,128.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$886.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$649.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$590.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.41
|
| Rate for Payer: BCBS Transplant Transplant |
$513.00
|
| Rate for Payer: Blue Shield of California Commercial |
$630.14
|
| Rate for Payer: Blue Shield of California EPN |
$499.32
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cigna of CA HMO |
$547.20
|
| Rate for Payer: Cigna of CA PPO |
$632.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$886.14
|
| Rate for Payer: Dignity Health Media |
$590.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$797.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$590.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$590.76
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$968.85
|
| Rate for Payer: Heritage Provider Network Transplant |
$968.85
|
| Rate for Payer: IEHP Medi-Cal |
$957.03
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$957.03
|
| Rate for Payer: IEHP Medicare Advantage |
$590.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$590.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.62
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$513.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO |
$427.50
|
| Rate for Payer: United Healthcare HMO Rider |
$427.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$886.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.84
|
| Rate for Payer: Vantage Medical Group Senior |
$590.76
|
|
|
HC ADMIN SOTROVIMAB INFUSION MA
|
Facility
IP
|
$855.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
949001325
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$726.75 |
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.00
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$69.52 |
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.54
|
| Rate for Payer: BCBS Transplant Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$46.43
|
| Rate for Payer: Blue Shield of California EPN |
$36.79
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Media |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO |
$31.50
|
| Rate for Payer: United Healthcare HMO Rider |
$31.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
|
|
HC ADMIN VACCINE FLU
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
942100151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC ADMIN VACCINE FLU
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
908600208
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.90
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$79.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: IEHP Medi-Cal |
$96.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$96.15
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC ADMIN VACCINE FLU
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
908600208
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC ADMIN VACCINE FLU
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
941000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC ADMIN VACCINE FLU
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
942100151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.90
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$79.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: IEHP Medi-Cal |
$96.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$96.15
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC ADMIN VACCINE FLU
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
941000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$97.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.15
|
| Rate for Payer: BCBS Transplant Transplant |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.90
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$79.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: IEHP Medi-Cal |
$96.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$96.15
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53.00
|
| Rate for Payer: United Healthcare HMO Rider |
$53.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
IP
|
$129.00
|
|
| Hospital Charge Code |
941009141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
OP
|
$129.00
|
|
| Hospital Charge Code |
941009141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.86
|
| Rate for Payer: BCBS Transplant Transplant |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$95.07
|
| Rate for Payer: Blue Shield of California EPN |
$75.34
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Media |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$978.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$978.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.53
|
| Rate for Payer: BCBS Transplant Transplant |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$56.75
|
| Rate for Payer: Blue Shield of California EPN |
$44.97
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Media |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.50
|
| Rate for Payer: United Healthcare All Other HMO |
$38.50
|
| Rate for Payer: United Healthcare HMO Rider |
$38.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC ADMIN VACCINE HEP B ADULT
|
Facility
OP
|
$37.00
|
|
| Hospital Charge Code |
908603024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.04
|
| Rate for Payer: BCBS Transplant Transplant |
$22.20
|
| Rate for Payer: Blue Shield of California Commercial |
$27.27
|
| Rate for Payer: Blue Shield of California EPN |
$21.61
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Media |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18.50
|
| Rate for Payer: United Healthcare HMO Rider |
$18.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
|
HC ADMIN VACCINE HEP B ADULT
|
Facility
IP
|
$37.00
|
|
| Hospital Charge Code |
908603024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
|
|
HC ADMIN VACCINE INFLUENZA 6-35 MON
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
908600539
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.64
|
| Rate for Payer: BCBS Transplant Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Media |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC ADMIN VACCINE INFLUENZA 6-35 MON
|
Facility
IP
|
$38.00
|
|
| Hospital Charge Code |
908600539
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC ADMIN VACCINE INFLUENZA ADMIN GT 3 YR
|
Facility
OP
|
$37.00
|
|
| Hospital Charge Code |
908600536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.04
|
| Rate for Payer: BCBS Transplant Transplant |
$22.20
|
| Rate for Payer: Blue Shield of California Commercial |
$27.27
|
| Rate for Payer: Blue Shield of California EPN |
$21.61
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Media |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18.50
|
| Rate for Payer: United Healthcare HMO Rider |
$18.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
|
HC ADMIN VACCINE INFLUENZA ADMIN GT 3 YR
|
Facility
IP
|
$37.00
|
|
| Hospital Charge Code |
908600536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
|
|
HC ADMIN VACCINE MEDI-CAL INFLUENZA 6-35 MON
|
Facility
IP
|
$30.06
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
908710590
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: Galaxy Health WC |
$25.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$19.54
|
| Rate for Payer: Prime Health Services Commercial |
$25.55
|
|
|
HC ADMIN VACCINE MEDI-CAL INFLUENZA 6-35 MON
|
Facility
OP
|
$30.06
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
908710590
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$66.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.88
|
| Rate for Payer: BCBS Transplant Transplant |
$18.04
|
| Rate for Payer: Blue Shield of California Commercial |
$22.15
|
| Rate for Payer: Blue Shield of California EPN |
$17.56
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cigna of CA HMO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$22.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Media |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.02
|
| Rate for Payer: Galaxy Health WC |
$25.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$19.54
|
| Rate for Payer: Prime Health Services Commercial |
$25.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO |
$15.03
|
| Rate for Payer: United Healthcare HMO Rider |
$15.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.55
|
| Rate for Payer: Vantage Medical Group Senior |
$25.55
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: BCBS Transplant Transplant |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$56.75
|
| Rate for Payer: Blue Shield of California EPN |
$44.97
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Media |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.50
|
| Rate for Payer: United Healthcare All Other HMO |
$38.50
|
| Rate for Payer: United Healthcare HMO Rider |
$38.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
