|
HC ADM SARSCOV2 PF PEDS (6MS -4YRS) 3MCG TRS-SUCR 3
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0083A
|
| Hospital Charge Code |
949001337
|
|
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 Non-Gatekeeper |
$69.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.02
|
| Rate for Payer: Blue Shield of California Commercial |
$68.32
|
| Rate for Payer: Blue Shield of California EPN |
$54.66
|
| 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 Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS -4YRS) 3MCG TRS-SUCR 3
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0083A
|
| Hospital Charge Code |
949001337
|
|
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 |
$72.13
|
| 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 Foundation Hospitals 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
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 0174A
|
| Hospital Charge Code |
949001357
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.02
|
| Rate for Payer: Blue Shield of California Commercial |
$67.10
|
| Rate for Payer: Blue Shield of California EPN |
$53.68
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 0174A
|
| Hospital Charge Code |
949001357
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.92
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.52
|
| Rate for Payer: Blue Shield of California Commercial |
$73.81
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$91.51 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.51
|
| Rate for Payer: Blue Shield of California Commercial |
$73.81
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$52.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$57.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.04
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.50
|
| Rate for Payer: TriValley Medical Group Senior |
$52.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.50
|
| Rate for Payer: Vantage Medical Group Senior |
$52.27
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.92
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC ADRENAL SCAN
|
Facility
|
OP
|
$2,998.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$2,497.70 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,852.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,499.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,142.78
|
| Rate for Payer: Blue Shield of California EPN |
$918.99
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,948.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,948.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,665.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,855.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,430.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,831.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1,665.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,499.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,499.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC ADRENAL SCAN
|
Facility
|
IP
|
$2,998.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$2,248.50 |
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,930.71
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,029.65
|
| Rate for Payer: Heritage Provider Network Senior |
$2,029.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$542.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$749.50
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL MDI/DPI INITIAL
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800330
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL MDI/DPI SUB
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800331
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$273.75 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$235.06
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.10
|
| Rate for Payer: Heritage Provider Network Senior |
$247.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.25
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
|
|
HC AERO INHAL PENTAMIDINE TX
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 94642
|
| Hospital Charge Code |
900800300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$237.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.94
|
| Rate for Payer: Heritage Provider Network Senior |
$225.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$174.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.60
|
| Rate for Payer: Heritage Provider Network Senior |
$208.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$160.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.03
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.15
|
| Rate for Payer: Heritage Provider Network Senior |
$228.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.60
|
| Rate for Payer: Heritage Provider Network Senior |
$208.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$160.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.03
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.15
|
| Rate for Payer: Heritage Provider Network Senior |
$228.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.25
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$327.80
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$422.46 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$281.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$323.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.87
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
