|
HC SALIVARY GLAND
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$292.40 |
| Rate for Payer: Adventist Health Commercial |
$68.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.60
|
| Rate for Payer: EPIC Health Plan Senior |
$137.60
|
| Rate for Payer: Galaxy Health WC |
$292.40
|
| Rate for Payer: Global Benefits Group Commercial |
$206.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.56
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Networks By Design Commercial |
$223.60
|
| Rate for Payer: Prime Health Services Commercial |
$292.40
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$808.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$757.19
|
| Rate for Payer: Blue Shield of California Commercial |
$754.60
|
| Rate for Payer: Blue Shield of California EPN |
$498.13
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC SARS COV-2 TOTAL AB
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900912263
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$292.59 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.59
|
| Rate for Payer: Blue Shield of California Commercial |
$49.51
|
| Rate for Payer: Blue Shield of California EPN |
$32.71
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.88
|
| Rate for Payer: EPIC Health Plan Senior |
$42.13
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.45
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.13
|
| Rate for Payer: United Healthcare All Other HMO |
$34.13
|
| Rate for Payer: United Healthcare HMO Rider |
$34.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Vantage Medical Group Senior |
$42.13
|
|
|
HC SARS COV-2 TOTAL AB
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900912263
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$86.70 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Senior |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.48
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
|
|
HC SARSCOV2 VAC MOD PEDS (6 MS-11 YRS) MRNA LNP 25MCG/0.25ML IM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
949001359
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HC SARSCOV2 VAC MOD PEDS (6 MS-11 YRS) MRNA LNP 25MCG/0.25ML IM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
949001359
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$350.42 |
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.42
|
| Rate for Payer: Blue Shield of California Commercial |
$154.80
|
| Rate for Payer: Blue Shield of California EPN |
$154.80
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SBBB ABO
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904713
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.19
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC SBBB ABO
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904713
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC SBBB ABO DISCREP ADD'L TEST
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
|
|
HC SBBB ABO DISCREP ADD'L TEST
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$141.95 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.46
|
| Rate for Payer: Blue Shield of California Commercial |
$111.72
|
| Rate for Payer: Blue Shield of California EPN |
$73.81
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC SBBB ANTIBODY ID PANEL (GEL)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904767
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.41
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SBBB ANTIBODY ID PANEL (GEL)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904767
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SBBB ANTIBODY ID PANEL (LISS)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.23
|
| Rate for Payer: Blue Shield of California Commercial |
$66.90
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SBBB ANTIBODY ID PANEL (LISS)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SBBB ANTIBODY ID PANEL (PEG)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904423
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SBBB ANTIBODY ID PANEL (PEG)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
900904423
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.41
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SBBB ANTIBODY SCREEN
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$94.35 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Senior |
$44.40
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
|
|
HC SBBB ANTIBODY SCREEN
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
900904747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$106.66 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.66
|
| Rate for Payer: Blue Shield of California Commercial |
$74.26
|
| Rate for Payer: Blue Shield of California EPN |
$49.06
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna of CA HMO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$82.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.19
|
| Rate for Payer: EPIC Health Plan Senior |
$9.77
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.91
|
| Rate for Payer: United Healthcare All Other HMO |
$7.91
|
| Rate for Payer: United Healthcare HMO Rider |
$7.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9.77
|
|
|
HC SBBB ANTI-CMV
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900904446
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.56
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SBBB ANTI-CMV
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
900904446
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SBBB ANTIGEN SCREENING CLASS I
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904574
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.83
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Senior |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
|
HC SBBB ANTIGEN SCREENING CLASS I
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904574
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: EPIC Health Plan Senior |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
|
|
HC SBBB ANTIGEN SCREENING CLASS II
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904769
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC SBBB ANTIGEN SCREENING CLASS II
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
900904769
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.60
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.57
|
| Rate for Payer: EPIC Health Plan Senior |
$6.35
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.99
|
| Rate for Payer: Vantage Medical Group Senior |
$6.35
|
|
