|
HC ADM SARSCOV2 MOD BV BOOSTER 50MCG/0.5ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0134A
|
| Hospital Charge Code |
949001350
|
|
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 ADM SARSCOV2 MOD BV BOOSTER 50MCG/0.5ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0134A
|
| Hospital Charge Code |
949001350
|
|
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 ADM SARSCOV2 MOD BV PEDS (6-11YRS) BOOSTER 25MCG/0.25ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0144A
|
| Hospital Charge Code |
949001352
|
|
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 ADM SARSCOV2 MOD BV PEDS (6-11YRS) BOOSTER 25MCG/0.25ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0144A
|
| Hospital Charge Code |
949001352
|
|
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 ADM SARSCOV2 MOD BV PEDS (6MS-5YRS) BOOSTER 10MCG/0.2ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0164A
|
| Hospital Charge Code |
949001353
|
|
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 ADM SARSCOV2 MOD BV PEDS (6MS-5YRS) BOOSTER 10MCG/0.2ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0164A
|
| Hospital Charge Code |
949001353
|
|
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 ADM SARSCOV2 NV 2ND 5MCG/0.5ML IM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0042A
|
| Hospital Charge Code |
949001340
|
|
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 ADM SARSCOV2 NV 2ND 5MCG/0.5ML IM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0042A
|
| Hospital Charge Code |
949001340
|
|
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 ADM SARSCOV2 PF BV BOOSTER 30MCG/0.3ML 12YRS OR OLDER
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0124A
|
| Hospital Charge Code |
949001346
|
|
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 ADM SARSCOV2 PF BV BOOSTER 30MCG/0.3ML 12YRS OR OLDER
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0124A
|
| Hospital Charge Code |
949001346
|
|
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 ADM SARSCOV2 PF BV PEDS (5-11YRS) BOOSTER 10MCG/0.2ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0154A
|
| Hospital Charge Code |
949001348
|
|
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 ADM SARSCOV2 PF BV PEDS (5-11YRS) BOOSTER 10MCG/0.2ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0154A
|
| Hospital Charge Code |
949001348
|
|
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 ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
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 ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
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 ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
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 ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$245.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$54.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.45
|
| 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 |
$54.45
|
| 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 |
$81.68
|
| Rate for Payer: Dignity Health Media |
$54.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$54.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.45
|
| 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 |
$89.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54.45
|
| Rate for Payer: InnovAge PACE Commercial |
$81.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.96
|
| 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 |
$57.72
|
| Rate for Payer: Riverside University Health System MISP |
$59.90
|
| 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 |
$81.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.90
|
| Rate for Payer: Vantage Medical Group Senior |
$54.45
|
|
|
HC ADRENAL SCAN
|
Facility
|
OP
|
$6,414.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$413.86 |
| Max. Negotiated Rate |
$5,772.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,189.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,129.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,789.39
|
| Rate for Payer: Blue Distinction Transplant |
$3,848.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,963.85
|
| Rate for Payer: Blue Shield of California EPN |
$3,117.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$2,886.30
|
| Rate for Payer: Cash Price |
$2,886.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,131.20
|
| Rate for Payer: Cigna of CA HMO |
$4,104.96
|
| Rate for Payer: Cigna of CA PPO |
$4,746.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$5,451.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,772.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,810.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$4,810.50
|
| Rate for Payer: Networks By Design Commercial |
$4,169.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,451.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,848.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC ADRENAL SCAN
|
Facility
|
IP
|
$6,414.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,282.80 |
| Max. Negotiated Rate |
$5,772.60 |
| Rate for Payer: Cash Price |
$2,886.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,565.60
|
| Rate for Payer: Galaxy Health WC |
$5,451.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,848.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,772.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,443.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,810.50
|
| Rate for Payer: Networks By Design Commercial |
$4,169.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,451.90
|
|
|
HC ADULT DAY CARE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.35
|
| Rate for Payer: Blue Distinction Transplant |
$68.40
|
| Rate for Payer: Blue Shield of California Commercial |
$71.71
|
| Rate for Payer: Blue Shield of California EPN |
$55.75
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Media |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$85.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Riverside University Health System MISP |
$45.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC ADULT DAY CARE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
905357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,016.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,168.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,168.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,788.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,403.01
|
| Rate for Payer: Blue Distinction Transplant |
$3,456.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,320.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,133.44
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Dignity Health Media |
$4,896.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,896.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,184.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,320.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,016.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,361.60
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,304.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,880.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,880.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,880.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,896.00
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
905357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,152.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,075.84
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,184.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,174.98
|
| Rate for Payer: United Healthcare All Other HMO |
$2,124.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2,078.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,900.80
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
IP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
905357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.00 |
| Max. Negotiated Rate |
$5,287.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,137.25
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,287.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,406.25
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,218.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,166.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,119.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,938.75
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
OP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
905357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,056.25 |
| Max. Negotiated Rate |
$5,287.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,231.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,231.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,844.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,470.95
|
| Rate for Payer: Blue Distinction Transplant |
$3,525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,406.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,196.00
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Dignity Health Media |
$4,993.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,993.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,287.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,406.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,056.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,463.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Multiplan Commercial |
$4,406.25
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,937.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,937.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,937.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,937.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,993.75
|
|
|
HC ADULT/PEDS DIALYSIS TREATMENT
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000300
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$404.80 |
| Max. Negotiated Rate |
$1,821.60 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,821.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$1,518.00
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
