|
HC ADMIN VACCINE FLU
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
942100151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.21
|
| Rate for Payer: Blue Distinction Transplant |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.14
|
| Rate for Payer: Blue Shield of California EPN |
$63.08
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$58.05
|
| 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 |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| 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: Health Plan of Nevada (Sierra) Other |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| 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: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| 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 |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
943109141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.35
|
| Rate for Payer: Blue Distinction Transplant |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.54
|
| Rate for Payer: Blue Shield of California EPN |
$66.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Media |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Riverside University Health System MISP |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other HMO |
$68.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
949009141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
943109141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
941009141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| 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 |
$70.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.21
|
| Rate for Payer: Blue Distinction Transplant |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.14
|
| Rate for Payer: Blue Shield of California EPN |
$63.08
|
| 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 Media |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$96.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| 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
|
| 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 Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
949009141
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.35
|
| Rate for Payer: Blue Distinction Transplant |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.54
|
| Rate for Payer: Blue Shield of California EPN |
$66.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Media |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Riverside University Health System MISP |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other HMO |
$68.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC ADMIN VACCINE H1N1
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
941009141
|
|
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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| 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 ADMIN VACCINE HAEMOPHILUS FLU B
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
911890648
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC ADMIN VACCINE HAEMOPHILUS FLU B
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
911890648
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$81.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.87
|
| Rate for Payer: Blue Distinction Transplant |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$52.84
|
| Rate for Payer: Blue Shield of California EPN |
$41.08
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Media |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Riverside University Health System MISP |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42.00
|
| Rate for Payer: United Healthcare HMO Rider |
$42.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
907200502
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$145.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.94
|
| Rate for Payer: Blue Distinction Transplant |
$55.80
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California EPN |
$45.48
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.47
|
| Rate for Payer: Blue Distinction Transplant |
$55.80
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California EPN |
$45.48
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Media |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Riverside University Health System MISP |
$37.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
907200502
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC ADMIN VACCINE HEPATITIS B
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 90747
|
| Hospital Charge Code |
908600203
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$55.80
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California EPN |
$45.48
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.05
|
| Rate for Payer: Dignity Health Media |
$79.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Riverside University Health System MISP |
$37.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.05
|
| Rate for Payer: Vantage Medical Group Senior |
$79.05
|
|
|
HC ADMIN VACCINE INFLUENZA
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
902890229
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Media |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC ADMIN VACCINE INFLUENZA
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
902890229
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC ADMIN VACCINE INFLUENZA 6-35 MON
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908600539
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC ADMIN VACCINE INFLUENZA 6-35 MON
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908600539
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.04
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.53
|
| Rate for Payer: Blue Shield of California EPN |
$19.07
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC ADMIN VACCINE INFLUENZA ADMIN GT 3 YR
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
908600536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC ADMIN VACCINE INFLUENZA ADMIN GT 3 YR
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
908600536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.45
|
| Rate for Payer: Blue Distinction Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.90
|
| Rate for Payer: Blue Shield of California EPN |
$18.58
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Media |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC ADMIN VACCINE INFLUENZA GT 3 YR
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
908702039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Blue Shield of California Commercial |
$48.00
|
| Rate for Payer: Blue Shield of California EPN |
$34.18
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$32.00
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.17
|
| Rate for Payer: United Healthcare All Other HMO |
$23.60
|
| Rate for Payer: United Healthcare HMO Rider |
$23.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.12
|
|
|
HC ADMIN VACCINE INFLUENZA GT 3 YR
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
908702039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.38
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| Rate for Payer: Blue Shield of California EPN |
$20.81
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$44.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.40
|
| Rate for Payer: Dignity Health Media |
$54.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$32.00
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Riverside University Health System MISP |
$25.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54.40
|
|
|
HC ADMIN VACCINE INFLUENZA GT 3YR
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
943100151
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.21
|
| Rate for Payer: Blue Distinction Transplant |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$81.14
|
| Rate for Payer: Blue Shield of California EPN |
$63.08
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$58.05
|
| 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 |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| 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: Health Plan of Nevada (Sierra) Other |
$96.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| 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: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| 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 |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC ADMIN VACCINE INFLUENZA GT 3YR
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
943100151
|
|
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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| 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
|
|
