|
HC VACCINE HEPATITIS B
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
942100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$179.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC VACCINE HEPATITIS B
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
941000003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$184.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.47
|
| Rate for Payer: BCBS Transplant Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.86
|
| Rate for Payer: Blue Shield of California EPN |
$144.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.00
|
| Rate for Payer: IEHP medi-cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE HEPATITITS B
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
943100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$179.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC VACCINE HEPATITITS B
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
943100003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$184.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.47
|
| Rate for Payer: BCBS Transplant Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.86
|
| Rate for Payer: Blue Shield of California EPN |
$144.42
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Central Health Plan Commercial |
$268.80
|
| Rate for Payer: Cigna of CA HMO |
$235.20
|
| Rate for Payer: Cigna of CA PPO |
$235.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$252.00
|
| Rate for Payer: IEHP medi-cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$168.00
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Riverside University Health MISP |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Other HMO |
$168.00
|
| Rate for Payer: United Healthcare HMO Rider |
$168.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
949002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Blue Shield of California Commercial |
$45.75
|
| Rate for Payer: Blue Shield of California EPN |
$32.57
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.38
|
| Rate for Payer: BCBS Transplant Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| Rate for Payer: Blue Shield of California EPN |
$20.81
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.75
|
| Rate for Payer: IEHP medi-cal |
$21.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.50
|
| Rate for Payer: United Healthcare All Other HMO |
$30.50
|
| Rate for Payer: United Healthcare HMO Rider |
$30.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
949002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.38
|
| Rate for Payer: BCBS Transplant Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| Rate for Payer: Blue Shield of California EPN |
$20.81
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.75
|
| Rate for Payer: IEHP medi-cal |
$21.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.50
|
| Rate for Payer: United Healthcare All Other HMO |
$30.50
|
| Rate for Payer: United Healthcare HMO Rider |
$30.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Blue Shield of California Commercial |
$45.75
|
| Rate for Payer: Blue Shield of California EPN |
$32.57
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC VACCINE INFLUENZA PRESERV FREE GT 3YR
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
943102039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.38
|
| Rate for Payer: BCBS Transplant Transplant |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| Rate for Payer: Blue Shield of California EPN |
$20.81
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.75
|
| Rate for Payer: IEHP medi-cal |
$21.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.50
|
| Rate for Payer: United Healthcare All Other HMO |
$30.50
|
| Rate for Payer: United Healthcare HMO Rider |
$30.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA PRESERV FREE GT 3YR
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
943102039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Blue Shield of California Commercial |
$45.75
|
| Rate for Payer: Blue Shield of California EPN |
$32.57
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC VACCINE PNEUMOCOCCAL
|
Facility
IP
|
$158.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
949000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC VACCINE PNEUMOCOCCAL
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
949000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.88
|
| 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 Exchange |
$76.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.35
|
| Rate for Payer: BCBS Transplant Transplant |
$94.80
|
| Rate for Payer: Blue Shield of California Commercial |
$99.38
|
| Rate for Payer: Blue Shield of California EPN |
$77.26
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| 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 |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$118.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: IEHP medi-cal |
$97.93
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Innovage PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: Riverside University Health MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.00
|
| Rate for Payer: United Healthcare All Other HMO |
$79.00
|
| Rate for Payer: United Healthcare HMO Rider |
$79.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.00
|
| 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 VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
949000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Blue Shield of California Commercial |
$151.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.87
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$151.50
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.00
|
| Rate for Payer: United Healthcare All Other HMO |
$101.00
|
| Rate for Payer: United Healthcare HMO Rider |
$101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Blue Shield of California Commercial |
$151.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.87
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$151.50
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.00
|
| Rate for Payer: United Healthcare All Other HMO |
$101.00
|
| Rate for Payer: United Healthcare HMO Rider |
$101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Blue Shield of California Commercial |
$151.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.87
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
949000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$151.50
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.00
|
| Rate for Payer: United Healthcare All Other HMO |
$101.00
|
| Rate for Payer: United Healthcare HMO Rider |
$101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23SDV
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
943100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$818.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$111.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.68
|
| Rate for Payer: BCBS Transplant Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$145.81
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$151.50
|
| Rate for Payer: IEHP medi-cal |
$133.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.00
|
| Rate for Payer: United Healthcare All Other HMO |
$101.00
|
| Rate for Payer: United Healthcare HMO Rider |
$101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23SDV
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
943100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Blue Shield of California Commercial |
$151.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.87
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$964.80
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$423.14
|
| Rate for Payer: Innovage PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| Rate for Payer: Riverside University Health MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
