|
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 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 CONFIRM
|
Facility
|
OP
|
$65.00
|
|
|
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 |
$13.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.63
|
| 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 |
$43.48
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| 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 |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| 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 |
$43.35
|
| 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 |
$15.60
|
| 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 |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| 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
|
|
|
HC SOM HIVE 86703
|
Facility
|
IP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$97.28 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.78
|
| Rate for Payer: EPIC Health Plan Senior |
$45.78
|
| Rate for Payer: Galaxy Health WC |
$97.28
|
| Rate for Payer: Global Benefits Group Commercial |
$68.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.47
|
| Rate for Payer: Multiplan Commercial |
$91.56
|
| Rate for Payer: Networks By Design Commercial |
$74.39
|
| Rate for Payer: Prime Health Services Commercial |
$97.28
|
|
|
HC SOM HIVE 86703
|
Facility
|
OP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$139.58 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$76.57
|
| Rate for Payer: Blue Shield of California EPN |
$50.59
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cigna of CA HMO |
$73.25
|
| Rate for Payer: Cigna of CA PPO |
$84.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$97.28
|
| Rate for Payer: Global Benefits Group Commercial |
$68.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$91.56
|
| Rate for Payer: Networks By Design Commercial |
$74.39
|
| Rate for Payer: Prime Health Services Commercial |
$97.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
OP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$166.51 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11.99
|
| Rate for Payer: Blue Shield of California EPN |
$7.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$11.47
|
| Rate for Payer: Cigna of CA PPO |
$13.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.19
|
| Rate for Payer: EPIC Health Plan Senior |
$17.92
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.01
|
| Rate for Payer: Multiplan Commercial |
$14.34
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: Prime Health Services Commercial |
$15.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare HMO Rider |
$14.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Vantage Medical Group Senior |
$17.92
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
IP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.17
|
| Rate for Payer: EPIC Health Plan Senior |
$7.17
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$14.34
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: Prime Health Services Commercial |
$15.23
|
|
|
HC SOM HPV
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM HPV
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.52
|
| 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 |
$260.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$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 |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| 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 |
$30.02
|
| 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 |
$10.80
|
| 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 |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$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 HROMOSOME ANALYSIS AMNIO
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
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 HROMOSOME ANALYSIS AMNIO
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$340.00 |
| 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 |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| 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 |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| 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: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| 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
|
| 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 |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
|
IP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.43
|
| Rate for Payer: Multiplan Commercial |
$24.78
|
| Rate for Payer: Networks By Design Commercial |
$20.13
|
| Rate for Payer: Prime Health Services Commercial |
$26.32
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
|
OP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$20.72
|
| Rate for Payer: Blue Shield of California EPN |
$13.69
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cigna of CA HMO |
$19.82
|
| Rate for Payer: Cigna of CA PPO |
$22.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$24.78
|
| Rate for Payer: Networks By Design Commercial |
$20.13
|
| Rate for Payer: Prime Health Services Commercial |
$26.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
|
OP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.05
|
| Rate for Payer: Blue Shield of California Commercial |
$30.41
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$29.09
|
| Rate for Payer: Cigna of CA PPO |
$33.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$36.36
|
| Rate for Payer: Networks By Design Commercial |
$29.54
|
| Rate for Payer: Prime Health Services Commercial |
$38.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
|
IP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$38.63 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.18
|
| Rate for Payer: EPIC Health Plan Senior |
$18.18
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$36.36
|
| Rate for Payer: Networks By Design Commercial |
$29.54
|
| Rate for Payer: Prime Health Services Commercial |
$38.63
|
|
|
HC SOM HSV AB SCREEN, IGM,S EIA
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900914087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.53 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Senior |
$6.37
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: Networks By Design Commercial |
$10.35
|
| Rate for Payer: Prime Health Services Commercial |
$13.53
|
|
|
HC SOM HSV AB SCREEN, IGM,S EIA
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900914087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.71
|
| Rate for Payer: Blue Shield of California Commercial |
$10.65
|
| Rate for Payer: Blue Shield of California EPN |
$7.04
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$12.74
|
| Rate for Payer: Networks By Design Commercial |
$10.35
|
| Rate for Payer: Prime Health Services Commercial |
$13.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
|
OP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$7.86
|
| Rate for Payer: Blue Shield of California EPN |
$5.19
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$8.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$9.40
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
|
IP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$9.40
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$14.66 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: EPIC Health Plan Senior |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$13.80
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.66
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.05
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cigna of CA HMO |
$11.04
|
| Rate for Payer: Cigna of CA PPO |
$12.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$13.80
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HTGFN 84432
|
Facility
|
IP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$139.30 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$131.10
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
|
