|
HC HLA-DP MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903902018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$759.90 |
| Rate for Payer: Adventist Health Commercial |
$178.80
|
| Rate for Payer: Cash Price |
$491.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: EPIC Health Plan Senior |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.56
|
| Rate for Payer: Multiplan Commercial |
$715.20
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$807.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.96
|
| Rate for Payer: Blue Shield of California Commercial |
$823.54
|
| Rate for Payer: Blue Shield of California EPN |
$544.10
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$761.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,005.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,025.58
|
| Rate for Payer: Blue Shield of California EPN |
$677.59
|
| Rate for Payer: Cash Price |
$843.15
|
| Rate for Payer: Cash Price |
$843.15
|
| Rate for Payer: Cigna of CA HMO |
$981.12
|
| Rate for Payer: Cigna of CA PPO |
$1,134.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$919.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$843.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$613.20
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$948.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$668.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$1,307.13 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$708.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$331.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$722.52
|
| Rate for Payer: Blue Shield of California EPN |
$477.36
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$799.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$331.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$220.74
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$329.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$220.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.79
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$648.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other HMO |
$178.80
|
| Rate for Payer: United Healthcare HMO Rider |
$178.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$220.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$331.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.81
|
| Rate for Payer: Vantage Medical Group Senior |
$220.74
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.98 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$539.89
|
| Rate for Payer: Blue Shield of California Commercial |
$495.73
|
| Rate for Payer: Blue Shield of California EPN |
$327.52
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.29
|
| Rate for Payer: EPIC Health Plan Senior |
$106.14
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.23
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| Rate for Payer: United Healthcare All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$407.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.84
|
| Rate for Payer: Multiplan Commercial |
$592.80
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$761.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$807.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.96
|
| Rate for Payer: Blue Shield of California Commercial |
$823.54
|
| Rate for Payer: Blue Shield of California EPN |
$544.10
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cash Price |
$677.05
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.22
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,005.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,025.58
|
| Rate for Payer: Blue Shield of California EPN |
$677.59
|
| Rate for Payer: Cash Price |
$843.15
|
| Rate for Payer: Cash Price |
$843.15
|
| Rate for Payer: Cigna of CA HMO |
$981.12
|
| Rate for Payer: Cigna of CA PPO |
$1,134.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$919.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$1,303.05 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$843.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$613.20
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$948.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.92
|
| Rate for Payer: Multiplan Commercial |
$1,226.40
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$825.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$825.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$1,193.36 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$874.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,193.36
|
| Rate for Payer: Blue Shield of California Commercial |
$892.45
|
| Rate for Payer: Blue Shield of California EPN |
$589.63
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.03
|
| Rate for Payer: EPIC Health Plan Senior |
$127.43
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$127.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$874.97
|
| 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 |
$892.45
|
| Rate for Payer: Blue Shield of California EPN |
$589.63
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| 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 |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| 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 |
$889.78
|
| 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 |
$320.16
|
| 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 |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| 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
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.71
|
| 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 |
$618.83
|
| Rate for Payer: Blue Shield of California EPN |
$408.85
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| 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 |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| 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 |
$616.98
|
| 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 |
$222.00
|
| 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 |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| 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
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$786.25 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.71
|
| 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 |
$618.83
|
| Rate for Payer: Blue Shield of California EPN |
$408.85
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| 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 |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| 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 |
$616.98
|
| 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 |
$222.00
|
| 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 |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| 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 |
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 |
$508.75
|
| 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
|
$925.00
|
|
|
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 |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.71
|
| 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 |
$618.83
|
| Rate for Payer: Blue Shield of California EPN |
$408.85
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| 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 |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| 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 |
$616.98
|
| 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 |
$222.00
|
| 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 |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| 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 |
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 |
$508.75
|
| 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 |
$508.75
|
| 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 |
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 |
$508.75
|
| 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
|
$925.00
|
|
|
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 |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$606.71
|
| 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 |
$618.83
|
| Rate for Payer: Blue Shield of California EPN |
$408.85
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cash Price |
$508.75
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| 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 |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| 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 |
$616.98
|
| 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 |
$222.00
|
| 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 |
$740.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| 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
|
|
