|
HC SOM VONWILLEBRAND AG
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$226.62 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.62
|
| Rate for Payer: Blue Shield of California Commercial |
$16.95
|
| Rate for Payer: Blue Shield of California EPN |
$11.20
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$20.27
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
IP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$63.07 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.68
|
| Rate for Payer: EPIC Health Plan Senior |
$29.68
|
| Rate for Payer: Galaxy Health WC |
$63.07
|
| Rate for Payer: Global Benefits Group Commercial |
$44.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.81
|
| Rate for Payer: Multiplan Commercial |
$59.36
|
| Rate for Payer: Networks By Design Commercial |
$48.23
|
| Rate for Payer: Prime Health Services Commercial |
$63.07
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
OP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$225.96 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.96
|
| Rate for Payer: Blue Shield of California Commercial |
$49.64
|
| Rate for Payer: Blue Shield of California EPN |
$32.80
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cigna of CA HMO |
$47.49
|
| Rate for Payer: Cigna of CA PPO |
$54.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Senior |
$30.86
|
| Rate for Payer: Galaxy Health WC |
$63.07
|
| Rate for Payer: Global Benefits Group Commercial |
$44.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.35
|
| Rate for Payer: Multiplan Commercial |
$59.36
|
| Rate for Payer: Networks By Design Commercial |
$48.23
|
| Rate for Payer: Prime Health Services Commercial |
$63.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$226.62 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.62
|
| Rate for Payer: Blue Shield of California Commercial |
$34.19
|
| Rate for Payer: Blue Shield of California EPN |
$22.59
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cigna of CA HMO |
$32.70
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$40.88
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$43.44 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.44
|
| Rate for Payer: EPIC Health Plan Senior |
$20.44
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.26
|
| Rate for Payer: Multiplan Commercial |
$40.88
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$94.89 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.89
|
| Rate for Payer: Blue Shield of California Commercial |
$18.14
|
| Rate for Payer: Blue Shield of California EPN |
$11.98
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$21.69
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.69
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM VPHIV 87900
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$1,259.39 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,259.39
|
| Rate for Payer: Blue Shield of California Commercial |
$116.61
|
| Rate for Payer: Blue Shield of California EPN |
$77.04
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cigna of CA HMO |
$111.55
|
| Rate for Payer: Cigna of CA PPO |
$128.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.97
|
| Rate for Payer: EPIC Health Plan Senior |
$130.35
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.67
|
| Rate for Payer: Multiplan Commercial |
$139.44
|
| Rate for Payer: Networks By Design Commercial |
$113.30
|
| Rate for Payer: Prime Health Services Commercial |
$148.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.59
|
| Rate for Payer: United Healthcare All Other HMO |
$105.59
|
| Rate for Payer: United Healthcare HMO Rider |
$105.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Vantage Medical Group Senior |
$130.35
|
|
|
HC SOM VPHIV 87900
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$148.16 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.72
|
| Rate for Payer: EPIC Health Plan Senior |
$69.72
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.83
|
| Rate for Payer: Multiplan Commercial |
$139.44
|
| Rate for Payer: Networks By Design Commercial |
$113.30
|
| Rate for Payer: Prime Health Services Commercial |
$148.16
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| 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 |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| 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 |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| 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 |
$16.68
|
| 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 |
$6.00
|
| 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 |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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 WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| 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 |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| 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 |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| 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 |
$16.68
|
| 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 |
$6.00
|
| 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 |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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 WEST NILE VIRUS AB
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.36
|
| Rate for Payer: Galaxy Health WC |
$15.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$14.71
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.63
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.78
|
| Rate for Payer: Blue Shield of California Commercial |
$12.30
|
| Rate for Payer: Blue Shield of California EPN |
$8.13
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cigna of CA HMO |
$11.77
|
| Rate for Payer: Cigna of CA PPO |
$13.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$15.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$14.71
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Adventist Health Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.26
|
| Rate for Payer: EPIC Health Plan Senior |
$6.26
|
| Rate for Payer: Galaxy Health WC |
$13.31
|
| Rate for Payer: Global Benefits Group Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$12.53
|
| Rate for Payer: Networks By Design Commercial |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$13.31
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$139.05 |
| Rate for Payer: Adventist Health Commercial |
$3.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.27
|
| 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 |
$139.05
|
| Rate for Payer: Blue Shield of California Commercial |
$10.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.92
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$10.02
|
| Rate for Payer: Cigna of CA PPO |
$11.59
|
| 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 |
$13.31
|
| Rate for Payer: Global Benefits Group Commercial |
$9.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| 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 |
$12.53
|
| Rate for Payer: Networks By Design Commercial |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$13.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.40
|
| 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 WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$13.35 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: Galaxy Health WC |
$13.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$12.57
|
| Rate for Payer: Networks By Design Commercial |
$10.21
|
| Rate for Payer: Prime Health Services Commercial |
$13.35
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$139.05 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.30
|
| 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 |
$139.05
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.94
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cigna of CA HMO |
$10.05
|
| Rate for Payer: Cigna of CA PPO |
$11.63
|
| 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 |
$13.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| 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 |
$12.57
|
| Rate for Payer: Networks By Design Commercial |
$10.21
|
| Rate for Payer: Prime Health Services Commercial |
$13.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.43
|
| 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 WEST NILE VIRUS AB IGM CSF
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.78
|
| Rate for Payer: Blue Shield of California Commercial |
$12.27
|
| Rate for Payer: Blue Shield of California EPN |
$8.11
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cigna of CA HMO |
$11.74
|
| Rate for Payer: Cigna of CA PPO |
$13.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$15.59
|
| Rate for Payer: Global Benefits Group Commercial |
$11.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$14.67
|
| Rate for Payer: Networks By Design Commercial |
$11.92
|
| Rate for Payer: Prime Health Services Commercial |
$15.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$15.59 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.34
|
| Rate for Payer: EPIC Health Plan Senior |
$7.34
|
| Rate for Payer: Galaxy Health WC |
$15.59
|
| Rate for Payer: Global Benefits Group Commercial |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$14.67
|
| Rate for Payer: Networks By Design Commercial |
$11.92
|
| Rate for Payer: Prime Health Services Commercial |
$15.59
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.13
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| 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 |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| 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 |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| 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 WEST NILE VIRUS PCR
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.13
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| 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 |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| 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 |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| 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 WEST NILE VIRUS PCR (CSF)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
