|
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 |
$1,316.05 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,083.92
|
| 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 |
$1,316.05
|
| Rate for Payer: Blue Shield of California Commercial |
$121.49
|
| Rate for Payer: Blue Shield of California Commercial |
$80.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.08
|
| Rate for Payer: EPIC Health Plan Senior |
$143.38
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$110.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.49
|
| 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: Galaxy Health WC |
$148.16
|
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.72
|
| Rate for Payer: EPIC Health Plan Senior |
$69.72
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.84
|
| 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
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11.27
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Cigna of CA PPO |
$20.85
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| 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 |
$12.99
|
| Rate for Payer: Blue Shield of California Commercial |
$19.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna of CA HMO |
$18.03
|
| 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 |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| 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 |
$17.89
|
| 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 |
$6.76
|
| 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 |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.90
|
| 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 IGM
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| 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 |
$12.99
|
| Rate for Payer: Blue Shield of California Commercial |
$19.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cigna of CA HMO |
$18.03
|
| Rate for Payer: Cigna of CA PPO |
$20.85
|
| 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 |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| 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 |
$17.89
|
| 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 |
$6.76
|
| 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 |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.90
|
| 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 IGM
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11.27
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.76
|
| Rate for Payer: Multiplan Commercial |
$22.54
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$170.11 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.09
|
| 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 |
$170.11
|
| Rate for Payer: Blue Shield of California Commercial |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$13.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.59
|
| 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 |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| 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
|
OP
|
$18.38
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$145.30 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| 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 |
$145.30
|
| Rate for Payer: Blue Shield of California Commercial |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$13.60
|
| 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 |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| 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 |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| 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 |
$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 IGG CSF
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$14.70
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$145.30 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| 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 |
$145.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.92
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cigna of CA HMO |
$13.77
|
| Rate for Payer: Cigna of CA PPO |
$15.92
|
| 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 |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| 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 |
$17.22
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.91
|
| 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
|
$21.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$17.22
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$170.11 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.09
|
| 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 |
$170.11
|
| Rate for Payer: Blue Shield of California Commercial |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.92
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cigna of CA HMO |
$13.77
|
| Rate for Payer: Cigna of CA PPO |
$15.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| 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 |
$17.22
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.91
|
| 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
|
$21.52
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$17.22
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| 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 |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| 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 |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| 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
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| 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 |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| 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 |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| 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
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
|
HC SOM WHEY IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM WHEY IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
OP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| 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 |
$103.56
|
| Rate for Payer: Blue Shield of California Commercial |
$156.58
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cigna of CA HMO |
$143.78
|
| Rate for Payer: Cigna of CA PPO |
$166.24
|
| 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 |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| 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 |
$142.65
|
| 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 |
$53.92
|
| 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 |
$179.72
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.79
|
| 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 Y ENTEROCOL AB A G M
|
Facility
|
IP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.93 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.86
|
| Rate for Payer: EPIC Health Plan Senior |
$89.86
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.92
|
| Rate for Payer: Multiplan Commercial |
$179.72
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
|
|
HC SOM ZINC
|
Facility
|
IP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$9.74
|
| Rate for Payer: Networks By Design Commercial |
$7.91
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
|
|
HC SOM ZINC
|
Facility
|
OP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cigna of CA HMO |
$7.79
|
| Rate for Payer: Cigna of CA PPO |
$9.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.79
|
| Rate for Payer: EPIC Health Plan Senior |
$12.53
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$9.74
|
| Rate for Payer: Networks By Design Commercial |
$7.91
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
