|
HC ADM FR MOD A/D SAME DT/HR
|
Facility
OP
|
$236.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$177.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$146.56
|
| Rate for Payer: Blue Shield of California EPN |
$138.53
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$153.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Senior |
$200.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: IEHP Medi-Cal |
$161.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$118.00
|
| Rate for Payer: TriValley Medical Group Senior |
$118.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC ADMINISTRATION OF XOFIGO
|
Facility
OP
|
$732.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$132.15 |
| Max. Negotiated Rate |
$590.60 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$502.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$475.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: Dignity Health Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$310.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.11
|
| Rate for Payer: Heritage Provider Network Senior |
$453.11
|
| Rate for Payer: Humana Medicare |
$310.84
|
| Rate for Payer: IEHP Medi-Cal |
$196.78
|
| Rate for Payer: IEHP Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$590.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.66
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$341.92
|
| Rate for Payer: TriValley Medical Group Senior |
$310.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC ADMINISTRATION OF XOFIGO
|
Facility
IP
|
$732.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$502.88
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.56
|
| Rate for Payer: Heritage Provider Network Senior |
$495.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
|
|
HC ADMIN SOTROVIMAB INFUSION MA
|
Facility
OP
|
$900.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
949001325
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$1,122.44 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,094.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| 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: Blue Shield of California Commercial |
$558.90
|
| Rate for Payer: Blue Shield of California EPN |
$528.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$886.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.84
|
| Rate for Payer: Dignity Health Senior |
$590.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$590.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Humana Medicare |
$590.76
|
| Rate for Payer: IEHP Medicare Advantage |
$590.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,122.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.36
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$649.84
|
| Rate for Payer: TriValley Medical Group Senior |
$590.76
|
| 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
|
$900.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
949001325
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
900501278
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
900501278
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Blue Shield of California Commercial |
$47.20
|
| Rate for Payer: Blue Shield of California EPN |
$44.61
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Senior |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.04
|
| Rate for Payer: Heritage Provider Network Senior |
$47.04
|
| Rate for Payer: IEHP Medi-Cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Blue Shield of California Commercial |
$49.06
|
| Rate for Payer: Blue Shield of California EPN |
$46.37
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Senior |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: IEHP Medi-Cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC ADMIN VACCINE FLU
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
908600208
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.59 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.22
|
| 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: Blue Shield of California Commercial |
$118.61
|
| Rate for Payer: Blue Shield of California EPN |
$112.12
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.23
|
| Rate for Payer: Heritage Provider Network Senior |
$118.23
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| 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
|
$191.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
908600208
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.22
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.31
|
| Rate for Payer: Heritage Provider Network Senior |
$129.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
IP
|
$81.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
900100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.65
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.84
|
| Rate for Payer: Heritage Provider Network Senior |
$54.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$418.63 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$342.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.63
|
| Rate for Payer: Blue Shield of California Commercial |
$57.75
|
| Rate for Payer: Blue Shield of California EPN |
$54.59
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Senior |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: IEHP Medi-Cal |
$226.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
OP
|
$81.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
900100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$112.76 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.65
|
| 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: Blue Shield of California Commercial |
$50.30
|
| Rate for Payer: Blue Shield of California EPN |
$47.55
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.14
|
| Rate for Payer: Heritage Provider Network Senior |
$50.14
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| 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 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 |
$5.44 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.65
|
| 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 |
$22.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.90
|
| Rate for Payer: Blue Shield of California Commercial |
$18.67
|
| Rate for Payer: Blue Shield of California EPN |
$17.65
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.55
|
| Rate for Payer: Dignity Health Senior |
$25.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.61
|
| Rate for Payer: Heritage Provider Network Senior |
$18.61
|
| Rate for Payer: IEHP Medi-Cal |
$16.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.03
|
| Rate for Payer: TriValley Medical Group Senior |
$15.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.55
|
| Rate for Payer: Vantage Medical Group Senior |
$25.55
|
|
|
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 |
$5.44 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Adventist Health Commercial |
$6.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.65
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.35
|
| Rate for Payer: Heritage Provider Network Senior |
$20.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$324.64 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$324.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$69.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.16
|
| Rate for Payer: Blue Shield of California Commercial |
$57.75
|
| Rate for Payer: Blue Shield of California EPN |
$54.59
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: Dignity Health Senior |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: IEHP Medi-Cal |
$215.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC ADMIN VACCINE MONKEYPOX 1ST
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
948000204
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.82
|
| Rate for Payer: Heritage Provider Network Senior |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
|
|
HC ADMIN VACCINE MONKEYPOX 1ST
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
948000204
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$167.24 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| 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: Blue Shield of California Commercial |
$69.55
|
| Rate for Payer: Blue Shield of California EPN |
$65.74
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: Dignity Health Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Humana Medicare |
$88.02
|
| Rate for Payer: IEHP Medi-Cal |
$6.96
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$167.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110.91
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.82
|
| Rate for Payer: TriValley Medical Group Senior |
$88.02
|
| 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
IP
|
$112.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
948000205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.82
|
| Rate for Payer: Heritage Provider Network Senior |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
|
|
HC ADMIN VACCINE MONKEYPOX EA ADD
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
948000205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| 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 |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$69.55
|
| Rate for Payer: Blue Shield of California EPN |
$65.74
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Senior |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: IEHP Medi-Cal |
$6.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADMIN VACCINE MONKEYPOX THROUGH 18 YRS ANY ROUTE, 1ST
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
948000202
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| 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 |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$69.55
|
| Rate for Payer: Blue Shield of California EPN |
$65.74
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Senior |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADMIN VACCINE MONKEYPOX THROUGH 18 YRS ANY ROUTE, 1ST
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
948000202
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.82
|
| Rate for Payer: Heritage Provider Network Senior |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
|
