|
HC SOM SPN 87206
|
Facility
|
IP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.47
|
| Rate for Payer: EPIC Health Plan Senior |
$19.47
|
| Rate for Payer: Galaxy Health WC |
$41.38
|
| Rate for Payer: Global Benefits Group Commercial |
$29.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$38.94
|
| Rate for Payer: Networks By Design Commercial |
$31.64
|
| Rate for Payer: Prime Health Services Commercial |
$41.38
|
|
|
HC SOM SPN 87206
|
Facility
|
OP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California Commercial |
$33.93
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cigna of CA HMO |
$31.16
|
| Rate for Payer: Cigna of CA PPO |
$36.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$41.38
|
| Rate for Payer: Global Benefits Group Commercial |
$29.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$38.94
|
| Rate for Payer: Networks By Design Commercial |
$31.64
|
| Rate for Payer: Prime Health Services Commercial |
$41.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SOM SSDNA 86226
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM SSDNA 86226
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.01
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.98
|
| Rate for Payer: EPIC Health Plan Senior |
$13.32
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
|
|
HC SOM ST2
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.15 |
| Max. Negotiated Rate |
$176.86 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.39
|
| Rate for Payer: Blue Shield of California Commercial |
$101.57
|
| Rate for Payer: Blue Shield of California Commercial |
$67.18
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cigna of CA HMO |
$93.27
|
| Rate for Payer: Cigna of CA PPO |
$107.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.74
|
| Rate for Payer: EPIC Health Plan Senior |
$83.16
|
| Rate for Payer: Galaxy Health WC |
$123.87
|
| Rate for Payer: Global Benefits Group Commercial |
$87.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.30
|
| Rate for Payer: Multiplan Commercial |
$116.58
|
| Rate for Payer: Networks By Design Commercial |
$94.72
|
| Rate for Payer: Prime Health Services Commercial |
$123.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.24
|
| Rate for Payer: United Healthcare All Other HMO |
$61.24
|
| Rate for Payer: United Healthcare HMO Rider |
$61.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Vantage Medical Group Senior |
$75.60
|
|
|
HC SOM ST2
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.15 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.29
|
| Rate for Payer: EPIC Health Plan Senior |
$58.29
|
| Rate for Payer: Galaxy Health WC |
$123.87
|
| Rate for Payer: Global Benefits Group Commercial |
$87.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.98
|
| Rate for Payer: Multiplan Commercial |
$116.58
|
| Rate for Payer: Networks By Design Commercial |
$94.72
|
| Rate for Payer: Prime Health Services Commercial |
$123.87
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.99
|
| Rate for Payer: Blue Shield of California Commercial |
$19.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna of CA HMO |
$18.03
|
| Rate for Payer: Cigna of CA PPO |
$20.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11.27
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11.27
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.99
|
| Rate for Payer: Blue Shield of California Commercial |
$19.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna of CA HMO |
$18.03
|
| Rate for Payer: Cigna of CA PPO |
$20.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM STONE ANALYSIS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM STONE ANALYSIS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$133.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.20
|
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.14
|
| Rate for Payer: Blue Shield of California Commercial |
$6.22
|
| Rate for Payer: Blue Shield of California Commercial |
$9.41
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM STREP PNEUMO SEROTYPE 10A (34)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 10A (34)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 1 (1)
|
Facility
|
IP
|
$65.62
|
|
|
Service Code
|
CPT 86581
|
| Hospital Charge Code |
900912845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$55.78 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Cash Price |
$65.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.25
|
| Rate for Payer: EPIC Health Plan Senior |
$26.25
|
| Rate for Payer: Galaxy Health WC |
$55.78
|
| Rate for Payer: Global Benefits Group Commercial |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$42.65
|
| Rate for Payer: Prime Health Services Commercial |
$55.78
|
|
|
HC SOM STREP PNEUMO SEROTYPE 1 (1)
|
Facility
|
OP
|
$65.62
|
|
|
Service Code
|
CPT 86581
|
| Hospital Charge Code |
900912845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.84
|
| Rate for Payer: Blue Shield of California Commercial |
$30.25
|
| Rate for Payer: Blue Shield of California Commercial |
$45.74
|
| Rate for Payer: Cash Price |
$65.62
|
| Rate for Payer: Cash Price |
$65.62
|
| Rate for Payer: Cigna of CA HMO |
$42.00
|
| Rate for Payer: Cigna of CA PPO |
$48.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.85
|
| Rate for Payer: EPIC Health Plan Senior |
$101.23
|
| Rate for Payer: Galaxy Health WC |
$55.78
|
| Rate for Payer: Global Benefits Group Commercial |
$39.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$150.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.32
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$42.65
|
| Rate for Payer: Prime Health Services Commercial |
$55.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.81
|
| Rate for Payer: United Healthcare All Other HMO |
$32.81
|
| Rate for Payer: United Healthcare HMO Rider |
$32.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.23
|
| Rate for Payer: Vantage Medical Group Senior |
$92.03
|
|
|
HC SOM STREP PNEUMO SEROTYPE 11A (43)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 11A (43)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 12F (12)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912852
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 12F (12)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912852
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 14 (14)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912853
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 14 (14)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912853
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
|
|
HC SOM STREP PNEUMO SEROTYPE 15B (54)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 15B (54)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 17F (17)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912854
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
