|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL GT 2YR
|
Facility
OP
|
$83.96
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908600179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$71.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: BCBS Transplant Transplant |
$50.38
|
| Rate for Payer: Blue Shield of California Commercial |
$61.88
|
| Rate for Payer: Blue Shield of California EPN |
$49.03
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cigna of CA HMO |
$53.73
|
| Rate for Payer: Cigna of CA PPO |
$62.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.37
|
| Rate for Payer: Dignity Health Media |
$71.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.58
|
| Rate for Payer: Galaxy Health WC |
$71.37
|
| Rate for Payer: Global Benefits Group Commercial |
$50.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$62.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.15
|
| Rate for Payer: Multiplan Commercial |
$67.17
|
| Rate for Payer: Networks By Design Commercial |
$54.57
|
| Rate for Payer: Prime Health Services Commercial |
$71.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$50.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Other HMO |
$41.98
|
| Rate for Payer: United Healthcare HMO Rider |
$41.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.37
|
| Rate for Payer: Vantage Medical Group Senior |
$71.37
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL GT 2YR
|
Facility
IP
|
$83.96
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908600179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$71.37 |
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.58
|
| Rate for Payer: Galaxy Health WC |
$71.37
|
| Rate for Payer: Global Benefits Group Commercial |
$50.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.15
|
| Rate for Payer: Multiplan Commercial |
$67.17
|
| Rate for Payer: Networks By Design Commercial |
$54.57
|
| Rate for Payer: Prime Health Services Commercial |
$71.37
|
|
|
HC ADMIN VACCINE MONKEYPOX 1ST
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
948000204
|
|
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 MONKEYPOX 1ST
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
948000204
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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 |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| 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 |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$142.59
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC ADMIN VACCINE MONKEYPOX EA ADD
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
948000205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.30
|
| 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 |
$90.10
|
| Rate for Payer: Dignity Health Media |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.40
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| 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
|
| 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 |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC ADMIN VACCINE MONKEYPOX EA ADD
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
948000205
|
|
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 MONKEYPOX THROUGH 18 YRS ANY ROUTE, 1ST
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
948000202
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$169.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$169.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.30
|
| 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 |
$90.10
|
| Rate for Payer: Dignity Health Media |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.40
|
| 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: 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
|
| 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 |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC ADMIN VACCINE MONKEYPOX THROUGH 18 YRS ANY ROUTE, 1ST
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
948000202
|
|
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 MONKEYPOX THROUGH 18 YRS ANY ROUTE, EA ADD
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
948000203
|
|
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 MONKEYPOX THROUGH 18 YRS ANY ROUTE, EA ADD
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
948000203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$83.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58.30
|
| 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 |
$90.10
|
| Rate for Payer: Dignity Health Media |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.40
|
| 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: 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
|
| 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 |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
941000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
941000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.85
|
| 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 |
$77.45
|
| Rate for Payer: BCBS Transplant Transplant |
$78.00
|
| Rate for Payer: Blue Shield of California Commercial |
$95.81
|
| Rate for Payer: Blue Shield of California EPN |
$75.92
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| 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 |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$97.50
|
| 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 |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| 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 |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.00
|
| Rate for Payer: United Healthcare All Other HMO |
$65.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.00
|
| 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 SINGLE
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$46.20
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| 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: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| 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: 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC ADMIN VACCINE SINGLE
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
Hospital Revenue Code
|
450
|
| 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 SINGLE
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
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 SINGLE
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| 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 |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| 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: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$142.59
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC ADM SARSCOV2 AZ 1ST 5X10 10VP/.5ML
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0021A
|
| Hospital Charge Code |
949001306
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 AZ 1ST 5X10 10VP/.5ML
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0021A
|
| Hospital Charge Code |
949001306
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: BCBS Transplant Transplant |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$82.54
|
| Rate for Payer: Blue Shield of California EPN |
$65.41
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Media |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 AZ 2ND 5X10 10VP/.5ML
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0022A
|
| Hospital Charge Code |
949001307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 AZ 2ND 5X10 10VP/.5ML
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0022A
|
| Hospital Charge Code |
949001307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: BCBS Transplant Transplant |
$67.20
|
| Rate for Payer: Blue Shield of California Commercial |
$82.54
|
| Rate for Payer: Blue Shield of California EPN |
$65.41
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Media |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADRENAL SCAN
|
Facility
OP
|
$6,752.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$413.86 |
| Max. Negotiated Rate |
$5,739.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,480.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,022.84
|
| Rate for Payer: BCBS Transplant Transplant |
$4,051.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,990.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,166.69
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: Cigna of CA HMO |
$4,321.28
|
| Rate for Payer: Cigna of CA PPO |
$4,996.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$5,739.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,064.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: IEHP Medi-Cal |
$2,874.12
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$5,401.60
|
| Rate for Payer: Networks By Design Commercial |
$4,388.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,739.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,051.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,051.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC ADRENAL SCAN
|
Facility
IP
|
$6,752.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,620.48 |
| Max. Negotiated Rate |
$5,739.20 |
| Rate for Payer: Cash Price |
$3,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.80
|
| Rate for Payer: Galaxy Health WC |
$5,739.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,503.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.48
|
| Rate for Payer: Multiplan Commercial |
$5,401.60
|
| Rate for Payer: Networks By Design Commercial |
$4,388.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,739.20
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
IP
|
$605.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
OP
|
$605.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cigna of CA HMO |
$387.20
|
| Rate for Payer: Cigna of CA PPO |
$447.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$453.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$437.04
|
| Rate for Payer: IEHP Medi-Cal |
$431.71
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$431.71
|
| Rate for Payer: IEHP Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
IP
|
$605.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
