|
HC ADMIN VACCINE MONKEYPOX THROUGH 18 YRS ANY ROUTE, EA ADD
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
948000203
|
|
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 |
$29.09
|
| 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, EA ADD
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
948000203
|
|
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 PNEUMOCOCCAL
|
Facility
IP
|
$209.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
900100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.58
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.49
|
| Rate for Payer: Heritage Provider Network Senior |
$141.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
OP
|
$209.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
900100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$143.58
|
| 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 |
$129.79
|
| Rate for Payer: Blue Shield of California EPN |
$122.68
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$135.85
|
| 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 |
$135.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.37
|
| Rate for Payer: Heritage Provider Network Senior |
$129.37
|
| 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 |
$37.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.25
|
| 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 |
$156.75
|
| 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 SINGLE
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
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 SINGLE
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$167.24 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| 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 |
$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 |
$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 |
$60.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| 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 |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| 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 |
$69.75
|
| 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 SINGLE
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
Hospital Revenue Code
|
450
|
| 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 SINGLE
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| 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 |
$1,756.00
|
| Rate for Payer: Cash Price |
$41.85
|
| 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 |
$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 |
$60.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Humana Medicare |
$88.02
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| 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 |
$69.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.07
|
| 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 MOD BV BOOSTER 50MCG/0.5ML
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0134A
|
| Hospital Charge Code |
949001350
|
|
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 ADM SARSCOV2 MOD BV BOOSTER 50MCG/0.5ML
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0134A
|
| Hospital Charge Code |
949001350
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 MOD BV PEDS (6-11YRS) BOOSTER 25MCG/0.25ML
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0144A
|
| Hospital Charge Code |
949001352
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 MOD BV PEDS (6-11YRS) BOOSTER 25MCG/0.25ML
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0144A
|
| Hospital Charge Code |
949001352
|
|
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 ADM SARSCOV2 MOD BV PEDS (6MS-5YRS) BOOSTER 10MCG/0.2ML
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0164A
|
| Hospital Charge Code |
949001353
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 MOD BV PEDS (6MS-5YRS) BOOSTER 10MCG/0.2ML
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0164A
|
| Hospital Charge Code |
949001353
|
|
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 ADM SARSCOV2 NV 2ND 5MCG/0.5ML IM
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0042A
|
| Hospital Charge Code |
949001340
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 NV 2ND 5MCG/0.5ML IM
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0042A
|
| Hospital Charge Code |
949001340
|
|
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 ADM SARSCOV2 PF BV BOOSTER 30MCG/0.3ML 12YRS OR OLDER
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0124A
|
| Hospital Charge Code |
949001346
|
|
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 ADM SARSCOV2 PF BV BOOSTER 30MCG/0.3ML 12YRS OR OLDER
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0124A
|
| Hospital Charge Code |
949001346
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 PF BV PEDS (5-11YRS) BOOSTER 10MCG/0.2ML
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0154A
|
| Hospital Charge Code |
949001348
|
|
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 ADM SARSCOV2 PF BV PEDS (5-11YRS) BOOSTER 10MCG/0.2ML
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0154A
|
| Hospital Charge Code |
949001348
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
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 ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
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 |
$59.86
|
| 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: 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 ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$103.46 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$54.45
|
| Rate for Payer: Blue Shield of California Commercial |
$80.11
|
| Rate for Payer: Blue Shield of California EPN |
$75.72
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$83.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.90
|
| Rate for Payer: Dignity Health Senior |
$54.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.85
|
| Rate for Payer: Heritage Provider Network Senior |
$79.85
|
| Rate for Payer: Humana Medicare |
$54.45
|
| Rate for Payer: IEHP Medi-Cal |
$62.40
|
| Rate for Payer: IEHP Medicare Advantage |
$54.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.61
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$59.90
|
| Rate for Payer: TriValley Medical Group Senior |
$54.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.90
|
| Rate for Payer: Vantage Medical Group Senior |
$54.45
|
|
|
HC ADRENAL SCAN
|
Facility
IP
|
$2,744.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$496.66 |
| Max. Negotiated Rate |
$2,058.00 |
| Rate for Payer: Adventist Health Commercial |
$548.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,885.13
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,857.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.00
|
| Rate for Payer: Multiplan Commercial |
$2,058.00
|
|
