|
HC ADM FR MOD A/D 2 DATES/ HR
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
902100005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
|
|
HC ADM FR MOD A/D 2 DATES/ HR
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
902100005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.45
|
| Rate for Payer: Blue Shield of California EPN |
$108.53
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$174.08
|
| Rate for Payer: Cigna of CA PPO |
$201.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Riverside University Health System MISP |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC ADM FR MOD A/D SAME DT/HR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$155.33
|
| Rate for Payer: Blue Shield of California EPN |
$97.75
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$208.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Riverside University Health System MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC ADM FR MOD A/D SAME DT/HR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC ADMIN BEBTELOVIMAB INJ
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT M0222
|
| Hospital Charge Code |
949001336
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Central Health Plan Commercial |
$604.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$567.00
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
|
|
HC ADMIN BEBTELOVIMAB INJ
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT M0222
|
| Hospital Charge Code |
949001336
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$642.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$415.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$366.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.77
|
| Rate for Payer: Blue Shield of California Commercial |
$479.30
|
| Rate for Payer: Blue Shield of California EPN |
$301.64
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Central Health Plan Commercial |
$604.80
|
| Rate for Payer: Cigna of CA HMO |
$483.84
|
| Rate for Payer: Cigna of CA PPO |
$559.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$642.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$642.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$642.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$680.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.20
|
| Rate for Payer: Multiplan Commercial |
$567.00
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
| Rate for Payer: Riverside University Health System MISP |
$302.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$378.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$642.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$642.60
|
| Rate for Payer: Vantage Medical Group Senior |
$642.60
|
|
|
HC ADMIN FLU VACCINE GT 3 YRS NOS
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
923502039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$48.92
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
|
HC ADMIN FLU VACCINE GT 3 YRS NOS
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
923502039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$137.13 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.77
|
| Rate for Payer: Blue Shield of California Commercial |
$25.88
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health System MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC ADMINISTRATION OF XOFIGO
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$2,249.10 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,999.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,749.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$999.60
|
| Rate for Payer: EPIC Health Plan Senior |
$999.60
|
| Rate for Payer: Galaxy Health WC |
$2,124.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,249.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,586.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,474.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.80
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
| Rate for Payer: Networks By Design Commercial |
$1,624.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
|
|
HC ADMINISTRATION OF XOFIGO
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$216.96 |
| Max. Negotiated Rate |
$2,249.10 |
| Rate for Payer: Adventist Health Commercial |
$499.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$300.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$377.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.37
|
| Rate for Payer: Blue Shield of California EPN |
$992.10
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Cash Price |
$1,124.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,999.20
|
| Rate for Payer: Cigna of CA HMO |
$1,599.36
|
| Rate for Payer: Cigna of CA PPO |
$1,849.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,749.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.18
|
| Rate for Payer: EPIC Health Plan Senior |
$330.12
|
| Rate for Payer: Galaxy Health WC |
$2,124.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,499.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,249.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$300.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,586.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$402.15
|
| Rate for Payer: Multiplan Commercial |
$1,874.25
|
| Rate for Payer: Networks By Design Commercial |
$1,624.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$300.11
|
| Rate for Payer: Prime Health Services Commercial |
$2,124.15
|
| Rate for Payer: Prime Health Services Medicare |
$318.12
|
| Rate for Payer: Riverside University Health System MISP |
$330.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,499.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$300.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$450.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.12
|
| Rate for Payer: Vantage Medical Group Senior |
$300.11
|
|
|
HC ADMIN VACCINE ADMIN MEDI-CAL HEP B IG
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 90371
|
| Hospital Charge Code |
908603025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
|
|
HC ADMIN VACCINE ADMIN MEDI-CAL HEP B IG
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 90371
|
| Hospital Charge Code |
908603025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$878.75 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$136.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$878.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$322.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.98
|
| Rate for Payer: Blue Shield of California Commercial |
$239.02
|
| Rate for Payer: Blue Shield of California EPN |
$150.42
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: Cigna of CA HMO |
$241.28
|
| Rate for Payer: Cigna of CA PPO |
$278.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.97
|
| Rate for Payer: EPIC Health Plan Senior |
$150.65
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$136.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.51
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$136.95
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Medicare |
$145.17
|
| Rate for Payer: Riverside University Health System MISP |
$150.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.50
|
| Rate for Payer: United Healthcare All Other HMO |
$188.50
|
| Rate for Payer: United Healthcare HMO Rider |
$188.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$136.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Vantage Medical Group Senior |
$150.65
|
|
|
HC ADMIN VACCINE DIPTHERIA TET TOX
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
907200500
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| 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 Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.19
|
| Rate for Payer: Blue Shield of California Commercial |
$55.79
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| 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 |
$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 |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| 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 |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| 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: 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 DIPTHERIA TET TOX
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
907200500
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| 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: Health Management Network EPO/PPO |
$79.20
|
| 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 |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.30
|
| Rate for Payer: Blue Shield of California Commercial |
$45.01
|
| Rate for Payer: Blue Shield of California EPN |
$28.33
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.70
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Riverside University Health System MISP |
$28.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
900501278
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$29.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.30
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.70
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Riverside University Health System MISP |
$28.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| 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 |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
900501278
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
910100171
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
910100171
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.30
|
| Rate for Payer: Blue Shield of California Commercial |
$45.01
|
| Rate for Payer: Blue Shield of California EPN |
$28.33
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.70
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Riverside University Health System MISP |
$28.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Central Health Plan Commercial |
$56.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.20
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
|
|
HC ADMIN VACCINE FLU
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
942100151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC ADMIN VACCINE FLU
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
908600208
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$76.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC ADMIN VACCINE FLU
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
941000151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$76.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC ADMIN VACCINE FLU
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
908600208
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC ADMIN VACCINE FLU
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
942100151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$76.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
