|
HC SOM HISTAMINE PLASMA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR1
|
Facility
|
IP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$125.90 |
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.25
|
| Rate for Payer: EPIC Health Plan Senior |
$59.25
|
| Rate for Payer: Galaxy Health WC |
$125.90
|
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$88.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.90
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR1
|
Facility
|
OP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$99.09
|
| Rate for Payer: Blue Shield of California EPN |
$65.47
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna of CA HMO |
$94.80
|
| Rate for Payer: Cigna of CA PPO |
$109.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$125.90
|
| Rate for Payer: Global Benefits Group Commercial |
$88.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
IP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$125.91 |
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.25
|
| Rate for Payer: EPIC Health Plan Senior |
$59.25
|
| Rate for Payer: Galaxy Health WC |
$125.91
|
| Rate for Payer: Global Benefits Group Commercial |
$88.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.91
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR2
|
Facility
|
OP
|
$148.13
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914671
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$125.91
|
| Rate for Payer: Adventist Health Commercial |
$29.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$99.10
|
| Rate for Payer: Blue Shield of California EPN |
$65.47
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cash Price |
$148.13
|
| Rate for Payer: Cigna of CA HMO |
$94.80
|
| Rate for Payer: Cigna of CA PPO |
$109.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: Global Benefits Group Commercial |
$88.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$96.28
|
| Rate for Payer: Prime Health Services Commercial |
$125.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
IP
|
$25.56
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$21.73 |
| Rate for Payer: Adventist Health Commercial |
$5.11
|
| Rate for Payer: Cash Price |
$25.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.22
|
| Rate for Payer: EPIC Health Plan Senior |
$10.22
|
| Rate for Payer: Galaxy Health WC |
$21.73
|
| Rate for Payer: Global Benefits Group Commercial |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.13
|
| Rate for Payer: Multiplan Commercial |
$20.45
|
| Rate for Payer: Networks By Design Commercial |
$16.61
|
| Rate for Payer: Prime Health Services Commercial |
$21.73
|
|
|
HC SOM HISTOPLASMA AB IMMUNODIFFUSION
|
Facility
|
OP
|
$25.56
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
900912643
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Adventist Health Commercial |
$5.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$17.10
|
| Rate for Payer: Blue Shield of California EPN |
$11.30
|
| Rate for Payer: Cash Price |
$25.56
|
| Rate for Payer: Cash Price |
$25.56
|
| Rate for Payer: Cigna of CA HMO |
$16.36
|
| Rate for Payer: Cigna of CA PPO |
$18.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.79
|
| Rate for Payer: Galaxy Health WC |
$21.73
|
| Rate for Payer: Global Benefits Group Commercial |
$15.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$20.45
|
| Rate for Payer: Networks By Design Commercial |
$16.61
|
| Rate for Payer: Prime Health Services Commercial |
$21.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.17
|
| Rate for Payer: United Healthcare All Other HMO |
$11.17
|
| Rate for Payer: United Healthcare HMO Rider |
$11.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Vantage Medical Group Senior |
$13.79
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
IP
|
$144.56
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Adventist Health Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$144.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Senior |
$57.82
|
| Rate for Payer: Galaxy Health WC |
$122.88
|
| Rate for Payer: Global Benefits Group Commercial |
$86.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.69
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Networks By Design Commercial |
$93.96
|
| Rate for Payer: Prime Health Services Commercial |
$122.88
|
|
|
HC SOM HISTOPLASMA/BLASTOMYCES PCR
|
Facility
|
OP
|
$144.56
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915469
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$28.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$96.71
|
| Rate for Payer: Blue Shield of California EPN |
$63.90
|
| Rate for Payer: Cash Price |
$144.56
|
| Rate for Payer: Cash Price |
$144.56
|
| Rate for Payer: Cigna of CA HMO |
$92.52
|
| Rate for Payer: Cigna of CA PPO |
$106.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$122.88
|
| Rate for Payer: Global Benefits Group Commercial |
$86.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Networks By Design Commercial |
$93.96
|
| Rate for Payer: Prime Health Services Commercial |
$122.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HIV-1 ANTIBODY
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.90
|
| Rate for Payer: EPIC Health Plan Senior |
$11.90
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.81
|
| Rate for Payer: Networks By Design Commercial |
$19.34
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
HC SOM HIV-1 ANTIBODY
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900915308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$87.71 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.71
|
| Rate for Payer: Blue Shield of California Commercial |
$19.91
|
| Rate for Payer: Blue Shield of California EPN |
$13.15
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cash Price |
$29.76
|
| Rate for Payer: Cigna of CA HMO |
$19.05
|
| Rate for Payer: Cigna of CA PPO |
$22.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$23.81
|
| Rate for Payer: Networks By Design Commercial |
$19.34
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC SOM HIV-1 GENOTYPIC RESISTANCE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 0219U
|
| Hospital Charge Code |
900915502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$4,329.29 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,329.29
|
| Rate for Payer: Blue Shield of California Commercial |
$267.60
|
| Rate for Payer: Blue Shield of California EPN |
$176.80
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$797.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.75
|
| Rate for Payer: EPIC Health Plan Senior |
$725.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,218.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,377.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$725.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$913.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$971.50
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$587.25
|
| Rate for Payer: United Healthcare All Other HMO |
$587.25
|
| Rate for Payer: United Healthcare HMO Rider |
$587.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$587.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$725.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,087.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$797.50
|
| Rate for Payer: Vantage Medical Group Senior |
$725.00
|
|
|
HC SOM HIV-1 PROVIRAL DNA
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
900914170
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.63
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HIV-1 PROVIRAL DNA
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
900914170
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC SOM HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.89
|
| Rate for Payer: EPIC Health Plan Senior |
$85.10
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.93
|
| Rate for Payer: United Healthcare All Other HMO |
$68.93
|
| Rate for Payer: United Healthcare HMO Rider |
$68.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$85.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIV2 86702
|
Facility
|
OP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.65
|
| Rate for Payer: Blue Shield of California Commercial |
$12.96
|
| Rate for Payer: Blue Shield of California EPN |
$8.56
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$14.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$12.59
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV2 86702
|
Facility
|
IP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$16.46 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Senior |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$15.50
|
| Rate for Payer: Networks By Design Commercial |
$12.59
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
OP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.65
|
| Rate for Payer: Blue Shield of California Commercial |
$30.27
|
| Rate for Payer: Blue Shield of California EPN |
$20.00
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cigna of CA HMO |
$28.95
|
| Rate for Payer: Cigna of CA PPO |
$33.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$38.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$36.19
|
| Rate for Payer: Networks By Design Commercial |
$29.41
|
| Rate for Payer: Prime Health Services Commercial |
$38.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
IP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$36.19
|
| Rate for Payer: Networks By Design Commercial |
$29.41
|
| Rate for Payer: Prime Health Services Commercial |
$38.45
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.65
|
| Rate for Payer: Blue Shield of California Commercial |
$38.67
|
| Rate for Payer: Blue Shield of California EPN |
$25.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna of CA HMO |
$36.99
|
| Rate for Payer: Cigna of CA PPO |
$42.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$49.13
|
| Rate for Payer: Global Benefits Group Commercial |
$34.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$46.24
|
| Rate for Payer: Networks By Design Commercial |
$37.57
|
| Rate for Payer: Prime Health Services Commercial |
$49.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$49.13 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.12
|
| Rate for Payer: EPIC Health Plan Senior |
$23.12
|
| Rate for Payer: Galaxy Health WC |
$49.13
|
| Rate for Payer: Global Benefits Group Commercial |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$46.24
|
| Rate for Payer: Networks By Design Commercial |
$37.57
|
| Rate for Payer: Prime Health Services Commercial |
$49.13
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.89
|
| Rate for Payer: EPIC Health Plan Senior |
$85.10
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.93
|
| Rate for Payer: United Healthcare All Other HMO |
$68.93
|
| Rate for Payer: United Healthcare HMO Rider |
$68.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$85.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
