|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
943100150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.88
|
| 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 |
$71.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| 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 |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| 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 |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| 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 |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.00
|
| Rate for Payer: United Healthcare All Other HMO |
$74.00
|
| Rate for Payer: United Healthcare HMO Rider |
$74.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.00
|
| 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 PNEUMOCOCCAL
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890225
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| 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 |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
900100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.88
|
| 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 |
$71.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| 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 |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| 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 |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| 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 |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.00
|
| Rate for Payer: United Healthcare All Other HMO |
$74.00
|
| Rate for Payer: United Healthcare HMO Rider |
$74.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.00
|
| 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 PNEUMOCOCCAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
941000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.88
|
| 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 |
$71.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| 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 |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| 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 |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| 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 |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.00
|
| Rate for Payer: United Healthcare All Other HMO |
$74.00
|
| Rate for Payer: United Healthcare HMO Rider |
$74.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.00
|
| 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 PNEUMOCOCCAL
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890225
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
941000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
900100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
949000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC ADMIN VACCINE PNEUMOCOCCAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
949000150
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.88
|
| 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 |
$71.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| 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 |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| 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 |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| 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 |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.00
|
| Rate for Payer: United Healthcare All Other HMO |
$74.00
|
| Rate for Payer: United Healthcare HMO Rider |
$74.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.00
|
| 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 SINGLE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
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 SINGLE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
943100152
|
|
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 SINGLE
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
943100152
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$99.38 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.88
|
| 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 |
$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 |
$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 |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| 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 |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| 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 |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| 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 |
$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 |
$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 SINGLE
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
900501277
|
|
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 VARICELLA-ZOSTER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
907200503
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC ADMIN VARICELLA-ZOSTER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
907200503
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,144.49 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,144.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.53
|
| Rate for Payer: Blue Shield of California Commercial |
$19.02
|
| Rate for Payer: Blue Shield of California EPN |
$11.97
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
OP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
915355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,416.62 |
| Max. Negotiated Rate |
$7,603.20 |
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$4,224.00
|
| Rate for Payer: Adventist Health Commercial |
$3,463.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,646.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,914.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,775.30
|
| Rate for Payer: Blue Shield of California EPN |
$4,257.79
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,180.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,180.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,416.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,364.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,669.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,984.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,463.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,913.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,379.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,068.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,068.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,180.80
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
IP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
915355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$7,603.20 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,775.30
|
| Rate for Payer: Blue Shield of California EPN |
$4,257.79
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,364.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,984.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.60
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,491.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
OP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
905355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,416.62 |
| Max. Negotiated Rate |
$7,603.20 |
| Rate for Payer: Adventist Health Commercial |
$3,463.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,646.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,914.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,775.30
|
| Rate for Payer: Blue Shield of California EPN |
$4,257.79
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,180.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,180.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,416.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,364.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,669.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,984.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,463.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,913.60
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$4,224.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,379.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,068.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,068.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,180.80
|
|
|
HC AD MLD SKT SNGL AXIS KNEE SACH
|
Facility
|
IP
|
$8,448.00
|
|
|
Service Code
|
CPT L5200
|
| Hospital Charge Code |
905355200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$7,603.20 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,775.30
|
| Rate for Payer: Blue Shield of California EPN |
$4,257.79
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,913.60
|
| Rate for Payer: Cigna of CA PPO |
$5,913.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,364.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,984.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.60
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,491.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,170.53
|
| Rate for Payer: United Healthcare All Other HMO |
$3,086.05
|
| Rate for Payer: United Healthcare HMO Rider |
$3,019.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,766.72
|
|
|
HC ADM SARSCOV2 AZ 1ST 5X10 10VP/.5ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0021A
|
| Hospital Charge Code |
949001306
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC ADM SARSCOV2 AZ 1ST 5X10 10VP/.5ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0021A
|
| Hospital Charge Code |
949001306
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.79
|
| Rate for Payer: Blue Shield of California EPN |
$51.47
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADM SARSCOV2 AZ 2ND 5X10 10VP/.5ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0022A
|
| Hospital Charge Code |
949001307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC ADM SARSCOV2 AZ 2ND 5X10 10VP/.5ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0022A
|
| Hospital Charge Code |
949001307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.79
|
| Rate for Payer: Blue Shield of California EPN |
$51.47
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADM SARSCOV2 MOD 1ST 100MCG/0.5ML
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 0011A
|
| Hospital Charge Code |
949001304
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA 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: 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 |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| 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 Medi-Cal |
$43.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.70
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$48.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC ADM SARSCOV2 MOD 1ST 100MCG/0.5ML
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 0011A
|
| Hospital Charge Code |
949001304
|
|
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
|
|
