|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.42
|
| 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
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| 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 Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.12
|
| Rate for Payer: Blue Shield of California Commercial |
$41.95
|
| Rate for Payer: Blue Shield of California Commercial |
$63.62
|
| Rate for Payer: Blue Shield of California Commercial |
$63.43
|
| Rate for Payer: Blue Shield of California Commercial |
$96.19
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO |
$58.24
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Cigna of CA PPO |
$67.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$11.36
|
| Rate for Payer: EPIC Health Plan Senior |
$11.36
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.32
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| 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 All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| 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 Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| 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
|
$248.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| 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 Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.53
|
| Rate for Payer: Blue Shield of California Commercial |
$41.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.33
|
| Rate for Payer: Blue Shield of California Commercial |
$62.73
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$11.36
|
| Rate for Payer: EPIC Health Plan Senior |
$11.36
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.42
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| 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 Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| 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 Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| 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 Commercial/Exchange |
$15.49
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| 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 Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.12
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$63.62
|
| Rate for Payer: Blue Shield of California Commercial |
$57.15
|
| Rate for Payer: Blue Shield of California Commercial |
$96.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Senior |
$11.36
|
| Rate for Payer: EPIC Health Plan Senior |
$11.36
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.32
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| 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 Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| 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 Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| 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 Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.42
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| 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
|
$223.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| 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 Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.22
|
| Rate for Payer: Blue Shield of California Commercial |
$44.72
|
| Rate for Payer: Blue Shield of California Commercial |
$102.80
|
| Rate for Payer: Blue Shield of California Commercial |
$67.61
|
| Rate for Payer: Blue Shield of California Commercial |
$155.43
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Cigna of CA HMO |
$62.08
|
| Rate for Payer: Cigna of CA HMO |
$142.72
|
| Rate for Payer: Cigna of CA PPO |
$165.02
|
| Rate for Payer: Cigna of CA PPO |
$71.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.98
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| 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 All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| 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 Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| 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 Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.59
|
| Rate for Payer: Blue Shield of California Commercial |
$147.06
|
| Rate for Payer: Blue Shield of California Commercial |
$62.23
|
| Rate for Payer: Blue Shield of California Commercial |
$222.34
|
| Rate for Payer: Blue Shield of California Commercial |
$94.09
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$204.16
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Cigna of CA PPO |
$236.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Senior |
$15.70
|
| Rate for Payer: EPIC Health Plan Senior |
$15.70
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.12
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| 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 All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.27
|
| 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 Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.21
|
| 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 |
$142.59 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| 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 Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.59
|
| Rate for Payer: Blue Shield of California Commercial |
$147.06
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$222.34
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$204.16
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$236.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Senior |
$15.70
|
| Rate for Payer: EPIC Health Plan Senior |
$15.70
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.12
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.12
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.56
|
| 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 All Other HMO |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.27
|
| 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 Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| 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 |
$2,774.34 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,774.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,506.33
|
| Rate for Payer: Blue Shield of California Commercial |
$445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.37
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$658.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$744.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC HEP B ADULT ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890237
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B ADULT ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890237
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEP B HIGH RISK ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890238
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEP B HIGH RISK ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890238
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B IMMUNE GLOBULIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890236
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B IMMUNE GLOBULIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890236
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HEP B LOW RISK ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890239
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC HEP B LOW RISK ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890239
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC HERMETIC CATH DRAIN LUMBAR KIT
|
Facility
|
IP
|
$632.91
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Networks By Design Commercial |
$316.45
|
| Rate for Payer: Adventist Health Commercial |
$126.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: Cigna of CA HMO |
$443.04
|
| Rate for Payer: Cigna of CA PPO |
$443.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.16
|
| Rate for Payer: EPIC Health Plan Senior |
$253.16
|
| Rate for Payer: Galaxy Health WC |
$537.97
|
| Rate for Payer: Global Benefits Group Commercial |
$379.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$506.33
|
| Rate for Payer: Prime Health Services Commercial |
$537.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.53
|
| Rate for Payer: United Healthcare All Other HMO |
$231.20
|
| Rate for Payer: United Healthcare HMO Rider |
$226.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.28
|
|
|
HC HERMETIC CATH DRAIN LUMBAR KIT
|
Facility
|
OP
|
$632.91
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$537.97 |
| Rate for Payer: Adventist Health Commercial |
$126.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.10
|
| Rate for Payer: Blue Shield of California Commercial |
$320.89
|
| Rate for Payer: Blue Shield of California Commercial |
$486.71
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: Cigna of CA HMO |
$443.04
|
| Rate for Payer: Cigna of CA PPO |
$443.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$537.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.16
|
| Rate for Payer: EPIC Health Plan Senior |
$253.16
|
| Rate for Payer: Galaxy Health WC |
$537.97
|
| Rate for Payer: Global Benefits Group Commercial |
$379.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$506.33
|
| Rate for Payer: Networks By Design Commercial |
$316.45
|
| Rate for Payer: Prime Health Services Commercial |
$537.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.53
|
| Rate for Payer: United Healthcare All Other HMO |
$231.20
|
| Rate for Payer: United Healthcare HMO Rider |
$226.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$537.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.97
|
| Rate for Payer: Vantage Medical Group Senior |
$537.97
|
|
|
HC HERMETIC VENTRCLR CATH SET 6MM
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
