|
HC ADMIN VACCINE LAIV3 VACCINE LIVE FOR INTRANASAL USE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
900200027
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$200.71 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.84
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC ADMIN VACCINE LAIV4 VACCINE FOR INTRANASAL USE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
900200031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC ADMIN VACCINE LAIV4 VACCINE FOR INTRANASAL USE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
900200031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$172.83 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.25
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC ADMIN VACCINE MEDI-CAL HEP B PEDS ADULT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
908603023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$220.18 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO |
$52.50
|
| Rate for Payer: United Healthcare HMO Rider |
$52.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC ADMIN VACCINE MEDI-CAL HEP B PEDS ADULT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
908603023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC ADMIN VACCINE MEDI-CAL INFLUENZA 6-35 MON
|
Facility
|
OP
|
$30.06
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
908710590
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$75.99 |
| Rate for Payer: Adventist Health Commercial |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.65
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cigna of CA HMO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$22.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.02
|
| Rate for Payer: Galaxy Health WC |
$25.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.04
|
| Rate for Payer: Multiplan Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$19.54
|
| Rate for Payer: Prime Health Services Commercial |
$25.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.03
|
| Rate for Payer: United Healthcare All Other HMO |
$15.03
|
| Rate for Payer: United Healthcare HMO Rider |
$15.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.55
|
| Rate for Payer: Vantage Medical Group Senior |
$25.55
|
|
|
HC ADMIN VACCINE MEDI-CAL INFLUENZA 6-35 MON
|
Facility
|
IP
|
$30.06
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
908710590
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$25.55 |
| Rate for Payer: Adventist Health Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.02
|
| Rate for Payer: Galaxy Health WC |
$25.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.21
|
| Rate for Payer: Multiplan Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$19.54
|
| Rate for Payer: Prime Health Services Commercial |
$25.55
|
|
|
HC ADMIN VACCINE MEDI-CAL MMR
|
Facility
|
IP
|
$83.96
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
908603007
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$71.37 |
| Rate for Payer: Adventist Health Commercial |
$16.79
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.58
|
| Rate for Payer: EPIC Health Plan Senior |
$33.58
|
| Rate for Payer: Galaxy Health WC |
$71.37
|
| Rate for Payer: Global Benefits Group Commercial |
$50.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.15
|
| Rate for Payer: Multiplan Commercial |
$67.17
|
| Rate for Payer: Networks By Design Commercial |
$54.57
|
| Rate for Payer: Prime Health Services Commercial |
$71.37
|
|
|
HC ADMIN VACCINE MEDI-CAL MMR
|
Facility
|
OP
|
$83.96
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
908603007
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$696.19 |
| Rate for Payer: Adventist Health Commercial |
$16.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$696.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.74
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cigna of CA HMO |
$53.73
|
| Rate for Payer: Cigna of CA PPO |
$62.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.58
|
| Rate for Payer: EPIC Health Plan Senior |
$33.58
|
| Rate for Payer: Galaxy Health WC |
$71.37
|
| Rate for Payer: Global Benefits Group Commercial |
$50.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.77
|
| Rate for Payer: Multiplan Commercial |
$67.17
|
| Rate for Payer: Networks By Design Commercial |
$54.57
|
| Rate for Payer: Prime Health Services Commercial |
$71.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Other HMO |
$41.98
|
| Rate for Payer: United Healthcare HMO Rider |
$41.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.37
|
| Rate for Payer: Vantage Medical Group Senior |
$71.37
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$35.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.10
|
| Rate for Payer: Vantage Medical Group Senior |
$73.10
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.43
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.20
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.00
|
| Rate for Payer: United Healthcare All Other HMO |
$43.00
|
| Rate for Payer: United Healthcare HMO Rider |
$43.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.10
|
| Rate for Payer: Vantage Medical Group Senior |
$73.10
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908710321
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL GT 2YR
|
Facility
|
IP
|
$83.96
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908600179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$71.37 |
| Rate for Payer: Adventist Health Commercial |
$16.79
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.58
|
| Rate for Payer: EPIC Health Plan Senior |
$33.58
|
| Rate for Payer: Galaxy Health WC |
$71.37
|
| Rate for Payer: Global Benefits Group Commercial |
$50.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.15
|
| Rate for Payer: Multiplan Commercial |
$67.17
|
| Rate for Payer: Networks By Design Commercial |
$54.57
|
| Rate for Payer: Prime Health Services Commercial |
$71.37
|
|
|
HC ADMIN VACCINE MEDI-CAL PNEUMOCOCCAL GT 2YR
|
Facility
|
OP
|
$83.96
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
908600179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Adventist Health Commercial |
$16.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.43
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cash Price |
$37.78
|
| Rate for Payer: Cigna of CA HMO |
$53.73
|
| Rate for Payer: Cigna of CA PPO |
$62.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.58
|
| Rate for Payer: EPIC Health Plan Senior |
$33.58
|
| Rate for Payer: Galaxy Health WC |
$71.37
|
| Rate for Payer: Global Benefits Group Commercial |
$50.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.77
|
| Rate for Payer: Multiplan Commercial |
$67.17
|
| Rate for Payer: Networks By Design Commercial |
$54.57
|
| Rate for Payer: Prime Health Services Commercial |
$71.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Other HMO |
$41.98
|
| Rate for Payer: United Healthcare HMO Rider |
$41.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.37
|
| Rate for Payer: Vantage Medical Group Senior |
$71.37
|
|
|
HC ADMIN VACCINE MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
900200052
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC ADMIN VACCINE MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
900200052
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$1,181.60 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,181.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.91
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$303.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC ADMIN VACCINE MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
900200015
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$2,109.26 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,469.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,109.26
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$385.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC ADMIN VACCINE MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
900200015
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC ADMIN VACCINE MENINGOCOCCAL
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
911890734
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$1,181.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,181.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.91
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$303.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42.00
|
| Rate for Payer: United Healthcare HMO Rider |
$42.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC ADMIN VACCINE MENINGOCOCCAL
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
911890734
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC ADMIN VACCINE MMR VIRUS IMMUNIZATION, SUBCUT
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
900200044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC ADMIN VACCINE MMR VIRUS IMMUNIZATION, SUBCUT
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
900200044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$696.19 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$696.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.74
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC ADMIN VACCINE MONKEYPOX 1ST
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
948000204
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.17
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC ADMIN VACCINE MONKEYPOX 1ST
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
948000204
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| 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
|
|
