|
HC HEPATITIS B CORE AB
|
Facility
|
IP
|
$106.51
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$90.53 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.60
|
| Rate for Payer: EPIC Health Plan Senior |
$42.60
|
| Rate for Payer: Galaxy Health WC |
$90.53
|
| Rate for Payer: Global Benefits Group Commercial |
$63.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.56
|
| Rate for Payer: Multiplan Commercial |
$85.21
|
| Rate for Payer: Networks By Design Commercial |
$69.23
|
| Rate for Payer: Prime Health Services Commercial |
$90.53
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.51
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.29
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$284.75 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.51
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.51
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM INDIVIDUAL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.51
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM INDIVIDUAL
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$281.35 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.44
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC HEPATITIS BE AB
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$110.12 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.12
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC HEPATITIS BE AB
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC HEPATITIS B SURFACE AG
|
Facility
|
OP
|
$93.34
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$98.68 |
| Rate for Payer: Adventist Health Commercial |
$18.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.68
|
| Rate for Payer: Blue Shield of California Commercial |
$62.44
|
| Rate for Payer: Blue Shield of California EPN |
$41.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna of CA HMO |
$59.74
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$79.34
|
| Rate for Payer: Global Benefits Group Commercial |
$56.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$74.67
|
| Rate for Payer: Networks By Design Commercial |
$60.67
|
| Rate for Payer: Prime Health Services Commercial |
$79.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE AG
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$101.94 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.94
|
| Rate for Payer: Blue Shield of California Commercial |
$60.21
|
| Rate for Payer: Blue Shield of California EPN |
$39.78
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$98.68 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.68
|
| Rate for Payer: Blue Shield of California Commercial |
$54.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.24
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$97.44
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.60
|
| Rate for Payer: Blue Shield of California Commercial |
$65.19
|
| Rate for Payer: Blue Shield of California EPN |
$43.07
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Cigna of CA HMO |
$62.36
|
| Rate for Payer: Cigna of CA PPO |
$72.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$77.95
|
| Rate for Payer: Networks By Design Commercial |
$63.34
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
OP
|
$141.07
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Commercial |
$28.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: Blue Shield of California Commercial |
$94.38
|
| Rate for Payer: Blue Shield of California EPN |
$62.35
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cigna of CA HMO |
$90.28
|
| Rate for Payer: Cigna of CA PPO |
$104.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: Galaxy Health WC |
$119.91
|
| Rate for Payer: Global Benefits Group Commercial |
$84.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$112.86
|
| Rate for Payer: Networks By Design Commercial |
$91.70
|
| Rate for Payer: Prime Health Services Commercial |
$119.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$271.15 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.60
|
| Rate for Payer: EPIC Health Plan Senior |
$127.60
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$271.15 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.60
|
| Rate for Payer: EPIC Health Plan Senior |
$127.60
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$136.45 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: Blue Shield of California Commercial |
$84.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.69
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.26
|
| Rate for Payer: EPIC Health Plan Senior |
$14.27
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$2,398.41 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$693.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,398.41
|
| Rate for Payer: Blue Shield of California Commercial |
$646.88
|
| Rate for Payer: Blue Shield of California EPN |
$427.03
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$658.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
