|
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 |
$1,114.42 |
| Max. Negotiated Rate |
$4,617.75 |
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Cash Price |
$3,386.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,168.29
|
| Rate for Payer: Heritage Provider Network Senior |
$4,168.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.25
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
|
|
HC HEPATITIS A AB IGM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC HEPATITIS A AB IGM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913613
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$99.39 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| 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 HMO/PPO |
$99.39
|
| Rate for Payer: Blue Shield of California Commercial |
$90.60
|
| Rate for Payer: Blue Shield of California EPN |
$72.67
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.39
|
| Rate for Payer: Dignity Health Senior |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.26
|
| Rate for Payer: TriValley Medical Group Senior |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.16
|
| 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
|
$350.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913617
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| 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 HMO/PPO |
$99.39
|
| Rate for Payer: Blue Shield of California Commercial |
$90.60
|
| Rate for Payer: Blue Shield of California EPN |
$72.67
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.39
|
| Rate for Payer: Dignity Health Senior |
$11.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.26
|
| Rate for Payer: TriValley Medical Group Senior |
$11.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.16
|
| 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
|
$350.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
900913617
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC HEPATITIS A AB TOTAL
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
900913612
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$109.40 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| 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 HMO/PPO |
$109.40
|
| Rate for Payer: Blue Shield of California Commercial |
$99.71
|
| Rate for Payer: Blue Shield of California EPN |
$79.97
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Senior |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.39
|
| Rate for Payer: TriValley Medical Group Senior |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.38
|
| 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
|
$74.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
900913612
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.10
|
| Rate for Payer: Heritage Provider Network Senior |
$50.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
|
|
HC HEPATITIS B CORE AB
|
Facility
|
OP
|
$106.51
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.17
|
| 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 HMO/PPO |
$106.52
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$58.58
|
| Rate for Payer: Cash Price |
$58.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.23
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.93
|
| Rate for Payer: Heritage Provider Network Senior |
$65.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$79.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| 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
|
Facility
|
IP
|
$106.51
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
900913614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$79.88 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Cash Price |
$58.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.11
|
| Rate for Payer: Heritage Provider Network Senior |
$72.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.63
|
| Rate for Payer: Multiplan Commercial |
$79.88
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.10
|
| Rate for Payer: Heritage Provider Network Senior |
$50.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| 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 HMO/PPO |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$75.95
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.81
|
| Rate for Payer: Heritage Provider Network Senior |
$45.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| 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
|
$335.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$179.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.15
|
| 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 HMO/PPO |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$75.95
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$207.37
|
| Rate for Payer: Heritage Provider Network Senior |
$207.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$159.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| 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
|
$335.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$251.25 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$226.79
|
| Rate for Payer: Heritage Provider Network Senior |
$226.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.75
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| 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 HMO/PPO |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$75.95
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| 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
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| 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 HMO/PPO |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$94.69
|
| Rate for Payer: Blue Shield of California EPN |
$75.95
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| 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
|
$331.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC HEPATITIS BE AB
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC HEPATITIS BE AB
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$101.78 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| 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 HMO/PPO |
$101.78
|
| Rate for Payer: Blue Shield of California Commercial |
$92.74
|
| Rate for Payer: Blue Shield of California EPN |
$74.38
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| 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
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| 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 HMO/PPO |
$91.21
|
| Rate for Payer: Blue Shield of California Commercial |
$83.12
|
| Rate for Payer: Blue Shield of California EPN |
$66.67
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Senior |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| 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
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.38
|
| 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 HMO/PPO |
$94.22
|
| Rate for Payer: Blue Shield of California Commercial |
$83.12
|
| Rate for Payer: Blue Shield of California EPN |
$66.67
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Senior |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.51
|
| Rate for Payer: Heritage Provider Network Senior |
$153.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| 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
|
$248.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.90
|
| Rate for Payer: Heritage Provider Network Senior |
$167.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| 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 HMO/PPO |
$91.21
|
| Rate for Payer: Blue Shield of California Commercial |
$83.12
|
| Rate for Payer: Blue Shield of California EPN |
$66.67
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Senior |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| 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
|
|
