|
HC HEPATIC W/HEMODYNAMI
|
Facility
|
OP
|
$13,097.00
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
909081643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$11,787.30 |
| Rate for Payer: Adventist Health Commercial |
$2,619.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,953.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,949.88
|
| Rate for Payer: Blue Shield of California EPN |
$5,199.51
|
| Rate for Payer: Cash Price |
$7,203.35
|
| Rate for Payer: Cash Price |
$7,203.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,477.60
|
| Rate for Payer: Cigna of CA HMO |
$8,382.08
|
| Rate for Payer: Cigna of CA PPO |
$9,691.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,132.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,858.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,787.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,735.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,619.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,822.75
|
| Rate for Payer: Networks By Design Commercial |
$8,513.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$11,132.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,858.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC HEPATIC W/O HEMODYNA
|
Facility
|
OP
|
$6,157.00
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
909081662
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.28 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,739.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,737.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,444.33
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,925.60
|
| Rate for Payer: Cigna of CA HMO |
$3,940.48
|
| Rate for Payer: Cigna of CA PPO |
$4,556.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,233.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,694.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,541.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,106.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
| Rate for Payer: Networks By Design Commercial |
$4,002.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$5,233.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,694.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,694.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC HEPATIC W/O HEMODYNA
|
Facility
|
IP
|
$6,157.00
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
909081662
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,231.40 |
| Max. Negotiated Rate |
$5,541.30 |
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,925.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,462.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,462.80
|
| Rate for Payer: Galaxy Health WC |
$5,233.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,694.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,541.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,345.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.40
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
| Rate for Payer: Networks By Design Commercial |
$4,002.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,233.45
|
|
|
HC HEPATITIS A AB IGM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
HC HEPATITIS A AB IGM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.26
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.26
|
| Rate for Payer: InnovAge PACE Commercial |
$16.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.26
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$11.94
|
| Rate for Payer: Riverside University Health System MISP |
$12.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.12
|
| Rate for Payer: United Healthcare HMO Rider |
$9.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.39
|
| Rate for Payer: Vantage Medical Group Senior |
$11.26
|
|
|
HC HEPATITIS A AB IGM INDIVIDUAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913617
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.07
|
| Rate for Payer: Blue Shield of California Commercial |
$59.49
|
| Rate for Payer: Blue Shield of California EPN |
$38.91
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.26
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.26
|
| Rate for Payer: InnovAge PACE Commercial |
$16.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.26
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Medicare |
$11.94
|
| Rate for Payer: Riverside University Health System MISP |
$12.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.12
|
| Rate for Payer: United Healthcare HMO Rider |
$9.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.39
|
| Rate for Payer: Vantage Medical Group Senior |
$11.26
|
|
|
HC HEPATITIS A AB IGM INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913617
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC HEPATITIS A AB TOTAL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
900913612
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$87.18 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$38.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: InnovAge PACE Commercial |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.39
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$13.13
|
| Rate for Payer: Riverside University Health System MISP |
$13.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.04
|
| Rate for Payer: United Healthcare All Other HMO |
$10.04
|
| Rate for Payer: United Healthcare HMO Rider |
$10.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC HEPATITIS A AB TOTAL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
900913612
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC HEPATITIS B CORE AB
|
Facility
|
IP
|
$95.86
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$86.27 |
| Rate for Payer: Adventist Health Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Central Health Plan Commercial |
$76.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.34
|
| Rate for Payer: EPIC Health Plan Senior |
$38.34
|
| Rate for Payer: Galaxy Health WC |
$81.48
|
| Rate for Payer: Global Benefits Group Commercial |
$57.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.17
|
| Rate for Payer: Multiplan Commercial |
$71.89
|
| Rate for Payer: Networks By Design Commercial |
$62.31
|
| Rate for Payer: Prime Health Services Commercial |
$81.48
|
|
|
HC HEPATITIS B CORE AB
|
Facility
|
OP
|
$95.86
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$86.27 |
| Rate for Payer: Adventist Health Commercial |
$19.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.23
|
| Rate for Payer: Blue Shield of California Commercial |
$58.19
|
| Rate for Payer: Blue Shield of California EPN |
$38.06
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Central Health Plan Commercial |
$76.69
|
| Rate for Payer: Cigna of CA HMO |
$61.35
|
| Rate for Payer: Cigna of CA PPO |
$70.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$81.48
|
| Rate for Payer: Global Benefits Group Commercial |
$57.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$71.89
|
| Rate for Payer: Networks By Design Commercial |
$62.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$81.48
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$82.87 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.82
|
| Rate for Payer: Blue Shield of California Commercial |
$38.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: InnovAge PACE Commercial |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.77
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$12.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.82
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: InnovAge PACE Commercial |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.77
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$12.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.82
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: InnovAge PACE Commercial |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.77
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$12.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM INDIVIDUAL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC HEPATITIS B CORE IGM INDIVIDUAL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.82
|
| Rate for Payer: Blue Shield of California Commercial |
$66.77
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: InnovAge PACE Commercial |
$17.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.77
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$12.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.53
|
| Rate for Payer: United Healthcare All Other HMO |
$9.53
|
| Rate for Payer: United Healthcare HMO Rider |
$9.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS BE AB
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC HEPATITIS BE AB
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$81.11 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.46
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC HEPATITIS B SURFACE AG
|
Facility
|
IP
|
$93.34
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$84.01 |
| Rate for Payer: Adventist Health Commercial |
$18.67
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Central Health Plan Commercial |
$74.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.34
|
| Rate for Payer: EPIC Health Plan Senior |
$37.34
|
| Rate for Payer: Galaxy Health WC |
$79.34
|
| Rate for Payer: Global Benefits Group Commercial |
$56.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.67
|
| Rate for Payer: Multiplan Commercial |
$70.00
|
| Rate for Payer: Networks By Design Commercial |
$60.67
|
| Rate for Payer: Prime Health Services Commercial |
$79.34
|
|
|
HC HEPATITIS B SURFACE AG
|
Facility
|
OP
|
$93.34
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$84.01 |
| Rate for Payer: Adventist Health Commercial |
$18.67
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.75
|
| Rate for Payer: Blue Shield of California Commercial |
$56.66
|
| Rate for Payer: Blue Shield of California EPN |
$37.06
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Central Health Plan Commercial |
$74.67
|
| Rate for Payer: Cigna of CA HMO |
$59.74
|
| Rate for Payer: Cigna of CA PPO |
$69.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$79.34
|
| Rate for Payer: Global Benefits Group Commercial |
$56.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: InnovAge PACE Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$70.00
|
| Rate for Payer: Networks By Design Commercial |
$60.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.33
|
| Rate for Payer: Prime Health Services Commercial |
$79.34
|
| Rate for Payer: Prime Health Services Medicare |
$10.95
|
| Rate for Payer: Riverside University Health System MISP |
$11.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.24
|
| Rate for Payer: Blue Shield of California Commercial |
$54.63
|
| Rate for Payer: Blue Shield of California EPN |
$35.73
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: InnovAge PACE Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.33
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$10.95
|
| Rate for Payer: Riverside University Health System MISP |
$11.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
