|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.54
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.57
|
| 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 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 |
$174.00 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| 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 |
$174.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.57
|
| Rate for Payer: EPIC Health Plan Senior |
$19.71
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$11.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.09
|
| 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 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 |
$282.26 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.26
|
| 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 |
$271.70
|
| Rate for Payer: Blue Shield of California Commercial |
$20.75
|
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| 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 HROMOSOME ANALYSIS AMNIO
|
Facility
|
IP
|
$319.98
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$271.98 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$319.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.99
|
| Rate for Payer: EPIC Health Plan Senior |
$127.99
|
| Rate for Payer: Galaxy Health WC |
$271.98
|
| Rate for Payer: Global Benefits Group Commercial |
$191.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$255.98
|
| Rate for Payer: Networks By Design Commercial |
$207.99
|
| Rate for Payer: Prime Health Services Commercial |
$271.98
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
|
OP
|
$319.98
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$271.98 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$223.03
|
| Rate for Payer: Blue Shield of California Commercial |
$147.51
|
| Rate for Payer: Cash Price |
$319.98
|
| Rate for Payer: Cash Price |
$319.98
|
| Rate for Payer: Cigna of CA HMO |
$204.79
|
| Rate for Payer: Cigna of CA PPO |
$236.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$271.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.99
|
| Rate for Payer: EPIC Health Plan Senior |
$127.99
|
| Rate for Payer: Galaxy Health WC |
$271.98
|
| Rate for Payer: Global Benefits Group Commercial |
$191.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$223.99
|
| Rate for Payer: Multiplan Commercial |
$255.98
|
| Rate for Payer: Networks By Design Commercial |
$207.99
|
| Rate for Payer: Prime Health Services Commercial |
$271.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.99
|
| 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 |
$271.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.98
|
| Rate for Payer: Vantage Medical Group Senior |
$271.98
|
|
|
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 |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| 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 |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$14.28
|
| Rate for Payer: Blue Shield of California Commercial |
$21.59
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$19.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.68
|
| 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 Foundation Hospitals Commercial/Self Funded |
$19.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.27
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.82
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.82
|
| 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 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 |
$199.64 |
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.94
|
| 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 |
$199.64
|
| Rate for Payer: Blue Shield of California Commercial |
$20.95
|
| Rate for Payer: Blue Shield of California Commercial |
$31.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$28.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| 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 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 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: Galaxy Health WC |
$13.53
|
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Senior |
$6.37
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| 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 |
$148.08 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| 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 |
$148.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7.34
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| 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 |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| 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 |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California Commercial |
$8.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$7.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.22
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.07
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.18
|
| 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 |
$199.64 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.94
|
| 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 |
$199.64
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$104.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.69
|
| 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
|
|
|
HC SOM HTGFN 84432
|
Facility
|
OP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$169.07 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.07
|
| Rate for Payer: Blue Shield of California Commercial |
$114.22
|
| Rate for Payer: Blue Shield of California Commercial |
$75.55
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Cigna of CA HMO |
$104.88
|
| Rate for Payer: Cigna of CA PPO |
$121.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.50
|
| Rate for Payer: EPIC Health Plan Senior |
$17.67
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.52
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Vantage Medical Group Senior |
$16.06
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
|
OP
|
$127.57
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$199.78 |
| Rate for Payer: Adventist Health Commercial |
$25.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.94
|
| 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 |
$199.78
|
| Rate for Payer: Blue Shield of California Commercial |
$58.81
|
| Rate for Payer: Blue Shield of California Commercial |
$88.92
|
| Rate for Payer: Cash Price |
$127.57
|
| Rate for Payer: Cash Price |
$127.57
|
| Rate for Payer: Cigna of CA HMO |
$81.64
|
| Rate for Payer: Cigna of CA PPO |
$94.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$108.43
|
| Rate for Payer: Global Benefits Group Commercial |
$76.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$81.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.62
|
| 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 |
$102.06
|
| Rate for Payer: Networks By Design Commercial |
$82.92
|
| Rate for Payer: Prime Health Services Commercial |
$108.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.54
|
| 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 HTLV AB CONFIRM
|
Facility
|
IP
|
$127.57
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$108.43 |
| Rate for Payer: Adventist Health Commercial |
$25.51
|
| Rate for Payer: Cash Price |
$127.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.03
|
| Rate for Payer: EPIC Health Plan Senior |
$51.03
|
| Rate for Payer: Galaxy Health WC |
$108.43
|
| Rate for Payer: Global Benefits Group Commercial |
$76.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$102.06
|
| Rate for Payer: Networks By Design Commercial |
$82.92
|
| Rate for Payer: Prime Health Services Commercial |
$108.43
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.94
|
| Rate for Payer: Blue Shield of California Commercial |
$8.98
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$10.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.95
|
|
|
HC SOM HUMAN HERPESVIRUS-6 PCR
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 87533
|
| Hospital Charge Code |
900912711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM HUMAN HERPESVIRUS-6 PCR
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 87533
|
| Hospital Charge Code |
900912711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$347.19 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$347.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.96
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.82
|
| Rate for Payer: United Healthcare All Other HMO |
$33.82
|
| Rate for Payer: United Healthcare HMO Rider |
$33.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Vantage Medical Group Senior |
$41.76
|
|
|
HC SOM HYPOGLYCEMIC AGENT SCREEN
|
Facility
|
OP
|
$101.03
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
900912528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$214.10 |
| Rate for Payer: Adventist Health Commercial |
$20.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.10
|
| Rate for Payer: Blue Shield of California Commercial |
$46.57
|
| Rate for Payer: Blue Shield of California Commercial |
$70.42
|
| Rate for Payer: Cash Price |
$101.03
|
| Rate for Payer: Cash Price |
$101.03
|
| Rate for Payer: Cigna of CA HMO |
$64.66
|
| Rate for Payer: Cigna of CA PPO |
$74.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.41
|
| Rate for Payer: EPIC Health Plan Senior |
$40.41
|
| Rate for Payer: Galaxy Health WC |
$85.88
|
| Rate for Payer: Global Benefits Group Commercial |
$60.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.72
|
| Rate for Payer: Multiplan Commercial |
$80.82
|
| Rate for Payer: Networks By Design Commercial |
$65.67
|
| Rate for Payer: Prime Health Services Commercial |
$85.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.52
|
| Rate for Payer: United Healthcare All Other HMO |
$50.52
|
| Rate for Payer: United Healthcare HMO Rider |
$50.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.88
|
| Rate for Payer: Vantage Medical Group Senior |
$85.88
|
|
