|
HC ADMIN VACCINE THROUGH 18 YRS ANY ROUTE, 1ST
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
948000206
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC ADMIN VACCINE THROUGH 18 YRS ANY ROUTE, 1ST
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
948000206
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.51
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$18.70
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
IP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
905355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,634.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,229.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,027.52
|
| Rate for Payer: Multiplan Commercial |
$6,758.40
|
| Rate for Payer: Networks By Design Commercial |
$4,224.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
IP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
915355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,634.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,229.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,027.52
|
| Rate for Payer: Multiplan Commercial |
$6,758.40
|
| Rate for Payer: Networks By Design Commercial |
$4,224.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
OP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
905355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,027.52 |
| Max. Negotiated Rate |
$7,180.80 |
| Rate for Payer: Adventist Health Commercial |
$3,463.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,646.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,893.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,234.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,105.73
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,180.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,360.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,634.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,669.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,229.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,027.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,913.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,913.60
|
| Rate for Payer: Multiplan Commercial |
$6,758.40
|
| Rate for Payer: Networks By Design Commercial |
$4,224.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,068.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,068.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,180.80
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
OP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
915355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,027.52 |
| Max. Negotiated Rate |
$7,180.80 |
| Rate for Payer: Adventist Health Commercial |
$3,463.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,646.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,893.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,234.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,105.73
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,180.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,360.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,634.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,669.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,229.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,027.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,913.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,913.60
|
| Rate for Payer: Multiplan Commercial |
$6,758.40
|
| Rate for Payer: Networks By Design Commercial |
$4,224.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,068.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,068.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,180.80
|
|
|
HC ADM SARSCOV2 AZ 1ST 5X10 10VP/.5ML
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0021A
|
| Hospital Charge Code |
949001306
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 AZ 1ST 5X10 10VP/.5ML
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0021A
|
| Hospital Charge Code |
949001306
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 AZ 2ND 5X10 10VP/.5ML
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0022A
|
| Hospital Charge Code |
949001307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 AZ 2ND 5X10 10VP/.5ML
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0022A
|
| Hospital Charge Code |
949001307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 MOD 1ST 100MCG/0.5ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 0011A
|
| Hospital Charge Code |
949001304
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.41
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC ADM SARSCOV2 MOD 1ST 100MCG/0.5ML
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 0011A
|
| Hospital Charge Code |
949001304
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC ADM SARSCOV2 MOD 2ND 100MCG/0.5ML
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 0012A
|
| Hospital Charge Code |
949001305
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC ADM SARSCOV2 MOD 2ND 100MCG/0.5ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 0012A
|
| Hospital Charge Code |
949001305
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.41
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC ADM SARSCOV2 MOD 50MCG/0.5 MLBST
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0094A
|
| Hospital Charge Code |
949001330
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 MOD 50MCG/0.5 MLBST
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0094A
|
| Hospital Charge Code |
949001330
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 MOD BOOSTER 50MCG/0.25ML
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0064A
|
| Hospital Charge Code |
949001317
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 MOD BOOSTER 50MCG/0.25ML
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0064A
|
| Hospital Charge Code |
949001317
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-4YRS) 1ST 50MCG/.5 ML IM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0091A
|
| Hospital Charge Code |
949001341
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-4YRS) 1ST 50MCG/.5 ML IM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0091A
|
| Hospital Charge Code |
949001341
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-4YRS) 2ND 50MCG/.5 ML IM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0092A
|
| Hospital Charge Code |
949001342
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-4YRS) 2ND 50MCG/.5 ML IM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0092A
|
| Hospital Charge Code |
949001342
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-4YRS) 3RD 50MCG/.5 ML IM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 0093A
|
| Hospital Charge Code |
949001343
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-4YRS) 3RD 50MCG/.5 ML IM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 0093A
|
| Hospital Charge Code |
949001343
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| 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 |
$68.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$95.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95.20
|
| Rate for Payer: Vantage Medical Group Senior |
$95.20
|
|
|
HC ADM SARSCOV2 MOD PEDS (6MS-5YRS) 3RD 25 MCG/0.25ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 0113A
|
| Hospital Charge Code |
949001344
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.41
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
