|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,059.56 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.56
|
| Rate for Payer: Blue Shield of California Commercial |
$126.44
|
| Rate for Payer: Blue Shield of California EPN |
$83.54
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Senior |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$798.36 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$531.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.36
|
| Rate for Payer: Blue Shield of California Commercial |
$541.89
|
| Rate for Payer: Blue Shield of California EPN |
$358.02
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Senior |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$798.36 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$531.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.36
|
| Rate for Payer: Blue Shield of California Commercial |
$541.89
|
| Rate for Payer: Blue Shield of California EPN |
$358.02
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Senior |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$725.75 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$515.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$725.75
|
| Rate for Payer: Blue Shield of California Commercial |
$525.83
|
| Rate for Payer: Blue Shield of California EPN |
$347.41
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Senior |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$725.75 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$515.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$725.75
|
| Rate for Payer: Blue Shield of California Commercial |
$525.83
|
| Rate for Payer: Blue Shield of California EPN |
$347.41
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Senior |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.88
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$700.68 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$343.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$700.68
|
| Rate for Payer: Blue Shield of California Commercial |
$350.56
|
| Rate for Payer: Blue Shield of California EPN |
$231.61
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna of CA HMO |
$335.36
|
| Rate for Payer: Cigna of CA PPO |
$387.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.81
|
| Rate for Payer: EPIC Health Plan Senior |
$109.49
|
| Rate for Payer: Galaxy Health WC |
$445.40
|
| Rate for Payer: Global Benefits Group Commercial |
$314.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$349.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$419.20
|
| Rate for Payer: Networks By Design Commercial |
$340.60
|
| Rate for Payer: Prime Health Services Commercial |
$445.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$314.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$314.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.60
|
| Rate for Payer: EPIC Health Plan Senior |
$325.60
|
| Rate for Payer: Galaxy Health WC |
$691.90
|
| Rate for Payer: Global Benefits Group Commercial |
$488.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$542.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$503.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.36
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Networks By Design Commercial |
$529.10
|
| Rate for Payer: Prime Health Services Commercial |
$691.90
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: Adventist Health Commercial |
$146.00
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$292.00
|
| Rate for Payer: Galaxy Health WC |
$620.50
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$451.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.46
|
| Rate for Payer: Blue Shield of California Commercial |
$237.50
|
| Rate for Payer: Blue Shield of California EPN |
$156.91
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cigna of CA HMO |
$227.20
|
| Rate for Payer: Cigna of CA PPO |
$262.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$355.49 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.49
|
| Rate for Payer: Blue Shield of California Commercial |
$175.95
|
| Rate for Payer: Blue Shield of California EPN |
$116.25
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$168.32
|
| Rate for Payer: Cigna of CA PPO |
$194.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Senior |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$654.50 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$616.00
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
|
|
HC HLA X MATCH T FLOW
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$700.68 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$413.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$700.68
|
| Rate for Payer: Blue Shield of California Commercial |
$421.47
|
| Rate for Payer: Blue Shield of California EPN |
$278.46
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$466.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.81
|
| Rate for Payer: EPIC Health Plan Senior |
$109.49
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH T FLOW
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$355.49 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.49
|
| Rate for Payer: Blue Shield of California Commercial |
$175.95
|
| Rate for Payer: Blue Shield of California EPN |
$116.25
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$168.32
|
| Rate for Payer: Cigna of CA PPO |
$194.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Senior |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$736.95 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$346.80
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$536.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.08
|
| Rate for Payer: Multiplan Commercial |
$693.60
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.60
|
| Rate for Payer: Blue Shield of California Commercial |
$216.09
|
| Rate for Payer: Blue Shield of California EPN |
$142.77
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.32
|
| Rate for Payer: EPIC Health Plan Senior |
$36.53
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.95
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.59
|
| Rate for Payer: United Healthcare All Other HMO |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.53
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$283.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$453.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.34
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cigna of CA HMO |
$442.24
|
| Rate for Payer: Cigna of CA PPO |
$511.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$587.35
|
| Rate for Payer: Global Benefits Group Commercial |
$414.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Networks By Design Commercial |
$449.15
|
| Rate for Payer: Prime Health Services Commercial |
$587.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$138.20 |
| Max. Negotiated Rate |
$587.35 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.40
|
| Rate for Payer: EPIC Health Plan Senior |
$276.40
|
| Rate for Payer: Galaxy Health WC |
$587.35
|
| Rate for Payer: Global Benefits Group Commercial |
$414.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Networks By Design Commercial |
$449.15
|
| Rate for Payer: Prime Health Services Commercial |
$587.35
|
|
