|
HC HEPARIN ASSAY, HPT (POC)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900912039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.69
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Media |
$13.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: InnovAge PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.88
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Other HMO |
$10.60
|
| Rate for Payer: United Healthcare HMO Rider |
$10.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC HEPARIN DOSE RESPONSE, HDR (POC)
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
900912040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC HEPARIN DOSE RESPONSE, HDR (POC)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
900912040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.04
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC HEPARIN NEUTRALIZED PT/PTT
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
900910094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC HEPARIN NEUTRALIZED PT/PTT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
900910094
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.23
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.83
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Caremore Medicare Advantage |
$11.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.76
|
| Rate for Payer: Dignity Health Media |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.84
|
| Rate for Payer: InnovAge PACE Commercial |
$17.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.87
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$12.55
|
| Rate for Payer: Riverside University Health System MISP |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.59
|
| Rate for Payer: United Healthcare All Other HMO |
$9.59
|
| Rate for Payer: United Healthcare HMO Rider |
$9.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
900912166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Blue Distinction Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.23
|
| Rate for Payer: Caremore Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Media |
$8.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: InnovAge PACE Commercial |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Medicare |
$8.66
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
900912166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$280.15
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC HEPATIC W/HEMODYNAMI
|
Facility
|
OP
|
$13,398.00
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
909081643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$12,058.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: Blue Distinction Transplant |
$8,038.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,279.96
|
| Rate for Payer: Blue Shield of California EPN |
$6,511.43
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,718.40
|
| Rate for Payer: Cigna of CA HMO |
$8,574.72
|
| Rate for Payer: Cigna of CA PPO |
$9,914.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,388.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,038.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,058.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,048.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,936.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,679.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,048.50
|
| Rate for Payer: Networks By Design Commercial |
$8,708.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,388.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,038.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,038.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC HEPATIC W/HEMODYNAMI
|
Facility
|
IP
|
$13,398.00
|
|
|
Service Code
|
CPT 75889
|
| Hospital Charge Code |
909081643
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,679.60 |
| Max. Negotiated Rate |
$12,058.20 |
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,718.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,359.20
|
| Rate for Payer: Galaxy Health WC |
$11,388.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,038.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,058.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,104.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,679.60
|
| Rate for Payer: Multiplan Commercial |
$10,048.50
|
| Rate for Payer: Networks By Design Commercial |
$8,708.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,388.30
|
|
|
HC HEPATIC W/O HEMODYNA
|
Facility
|
IP
|
$6,299.00
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
909081662
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,259.80 |
| Max. Negotiated Rate |
$5,669.10 |
| Rate for Payer: Cash Price |
$2,834.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,039.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,519.60
|
| Rate for Payer: Galaxy Health WC |
$5,354.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,779.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,669.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,399.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.80
|
| Rate for Payer: Multiplan Commercial |
$4,724.25
|
| Rate for Payer: Networks By Design Commercial |
$4,094.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,354.15
|
|
|
HC HEPATIC W/O HEMODYNA
|
Facility
|
OP
|
$6,299.00
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
909081662
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$864.40 |
| Max. Negotiated Rate |
$6,571.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$864.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: Blue Distinction Transplant |
$3,779.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,892.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,061.31
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$2,834.55
|
| Rate for Payer: Cash Price |
$2,834.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,039.20
|
| Rate for Payer: Cigna of CA HMO |
$4,031.36
|
| Rate for Payer: Cigna of CA PPO |
$4,661.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$5,354.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,779.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,669.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,724.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,201.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$4,724.25
|
| Rate for Payer: Networks By Design Commercial |
$4,094.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,354.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,779.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,779.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC HEPATITIS A AB IGM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| 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 |
$96.60
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.89
|
| Rate for Payer: Dignity Health Media |
$11.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.26
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.58
|
| 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 |
$18.68
|
| 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 |
$5.60
|
| 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 |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| 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 |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| 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: 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
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC HEPATITIS A AB IGM INDIVIDUAL
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913617
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC HEPATITIS A AB IGM INDIVIDUAL
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913617
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| 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 |
$96.60
|
| Rate for Payer: Blue Distinction Transplant |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California EPN |
$20.90
|
| Rate for Payer: Caremore Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.89
|
| Rate for Payer: Dignity Health Media |
$11.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.26
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.58
|
| 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 |
$28.68
|
| 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 |
$8.60
|
| 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 |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| 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 |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| 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: 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 TOTAL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
900913612
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC HEPATITIS A AB TOTAL
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
900913612
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$106.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.58
|
| 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 |
$106.34
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.58
|
| Rate for Payer: Dignity Health Media |
$12.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: InnovAge PACE Commercial |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| 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 |
$4.40
|
| 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 |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| 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 |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$18.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC HEPATITIS B CORE AB
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$103.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$103.53
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| 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 |
$3.40
|
| 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 |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| 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 |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HEPATITIS B CORE AB
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$101.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.39
|
| 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 |
$101.08
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Media |
$11.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.42
|
| 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 |
$14.67
|
| 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 |
$4.40
|
| 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 |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| 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 |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$101.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.39
|
| 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 |
$101.08
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Media |
$11.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.42
|
| 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 |
$30.02
|
| 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 |
$9.00
|
| 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 |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$101.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.39
|
| 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 |
$101.08
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Media |
$11.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.77
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.42
|
| 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 |
$30.02
|
| 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 |
$9.00
|
| 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 |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
