|
HC SOM STONE ANALYSIS
|
Facility
|
OP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.46
|
| Rate for Payer: Blue Distinction Transplant |
$9.98
|
| Rate for Payer: Blue Shield of California Commercial |
$10.28
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Caremore Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Central Health Plan Commercial |
$13.30
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$12.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Media |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: InnovAge PACE Commercial |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$12.47
|
| Rate for Payer: Networks By Design Commercial |
$10.81
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
| Rate for Payer: Prime Health Services Medicare |
$13.67
|
| Rate for Payer: Riverside University Health System MISP |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM STREP PNEUMO SEROTYPE 10A (34)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 10A (34)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 1 (1)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 1 (1)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 11A (43)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 11A (43)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 12F (12)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912852
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 12F (12)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912852
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 14 (14)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912853
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 14 (14)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912853
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 15B (54)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 15B (54)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 17F (17)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912854
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 17F (17)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912854
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 18C (56)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912864
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 18C (56)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912864
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 19A (57)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912865
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.43
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 19A (57)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912865
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREP PNEUMO SEROTYPE 19F (19)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912855
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 19F (19)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912855
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 20 (20)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912856
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 20 (20)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912856
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
|
HC SOM STREP PNEUMO SEROTYPE 2 (2)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912846
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: Blue Distinction Transplant |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2.47
|
| Rate for Payer: Blue Shield of California EPN |
$1.94
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$2.56
|
| Rate for Payer: Cigna of CA PPO |
$2.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Media |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 2 (2)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912846
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Central Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.60
|
| Rate for Payer: Galaxy Health WC |
$3.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.00
|
| Rate for Payer: Networks By Design Commercial |
$2.60
|
| Rate for Payer: Prime Health Services Commercial |
$3.40
|
|
