|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$801.40 |
| Max. Negotiated Rate |
$3,405.95 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,804.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,602.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,602.80
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,544.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,364.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
OP
|
$4,007.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,866.09 |
| Rate for Payer: Adventist Health Commercial |
$801.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,622.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,866.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,847.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,792.88
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cash Price |
$1,803.15
|
| Rate for Payer: Cigna of CA HMO |
$2,564.48
|
| Rate for Payer: Cigna of CA PPO |
$2,965.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,804.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$553.38
|
| Rate for Payer: EPIC Health Plan Senior |
$368.92
|
| Rate for Payer: Galaxy Health WC |
$3,405.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,404.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,544.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$961.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$3,205.60
|
| Rate for Payer: Networks By Design Commercial |
$2,604.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,405.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,404.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,404.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$335.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$323.33 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.33
|
| Rate for Payer: Blue Shield of California Commercial |
$179.79
|
| Rate for Payer: Blue Shield of California Commercial |
$127.24
|
| Rate for Payer: Blue Shield of California Commercial |
$271.83
|
| Rate for Payer: Blue Shield of California Commercial |
$192.37
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$176.64
|
| Rate for Payer: Cigna of CA PPO |
$204.24
|
| Rate for Payer: Cigna of CA PPO |
$288.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.91
|
| Rate for Payer: EPIC Health Plan Senior |
$70.61
|
| Rate for Payer: EPIC Health Plan Senior |
$70.61
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.01
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.99
|
| Rate for Payer: United Healthcare All Other HMO |
$51.99
|
| Rate for Payer: United Healthcare All Other HMO |
$51.99
|
| Rate for Payer: United Healthcare HMO Rider |
$51.99
|
| Rate for Payer: United Healthcare HMO Rider |
$51.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Vantage Medical Group Senior |
$64.19
|
| Rate for Payer: Vantage Medical Group Senior |
$64.19
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$3,684.17 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Adventist Health Commercial |
$148.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,996.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,996.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,684.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,684.17
|
| Rate for Payer: Blue Shield of California Commercial |
$342.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,021.80
|
| Rate for Payer: Blue Shield of California Commercial |
$517.87
|
| Rate for Payer: Blue Shield of California Commercial |
$675.83
|
| Rate for Payer: Cash Price |
$334.35
|
| Rate for Payer: Cash Price |
$334.35
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna of CA HMO |
$475.52
|
| Rate for Payer: Cigna of CA HMO |
$938.24
|
| Rate for Payer: Cigna of CA PPO |
$1,084.84
|
| Rate for Payer: Cigna of CA PPO |
$549.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$403.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$403.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,026.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$520.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.92
|
| Rate for Payer: EPIC Health Plan Senior |
$443.95
|
| Rate for Payer: EPIC Health Plan Senior |
$443.95
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Galaxy Health WC |
$631.55
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Global Benefits Group Commercial |
$445.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$661.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$661.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$403.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$403.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$930.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$471.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$456.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$456.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$540.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$540.81
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Networks By Design Commercial |
$482.95
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
| Rate for Payer: Prime Health Services Commercial |
$631.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$445.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$879.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$445.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.91
|
| Rate for Payer: United Healthcare All Other HMO |
$326.91
|
| Rate for Payer: United Healthcare All Other HMO |
$326.91
|
| Rate for Payer: United Healthcare HMO Rider |
$326.91
|
| Rate for Payer: United Healthcare HMO Rider |
$326.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$403.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$403.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Vantage Medical Group Senior |
$403.59
|
| Rate for Payer: Vantage Medical Group Senior |
$403.59
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,246.10 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,026.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$930.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$864.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$438.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.80
|
| Rate for Payer: EPIC Health Plan Senior |
$250.80
|
| Rate for Payer: Galaxy Health WC |
$532.95
|
| Rate for Payer: Global Benefits Group Commercial |
$376.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.48
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: Networks By Design Commercial |
$407.55
|
| Rate for Payer: Prime Health Services Commercial |
$532.95
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$598.51 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.51
|
| Rate for Payer: Blue Shield of California Commercial |
$289.05
|
| Rate for Payer: Blue Shield of California Commercial |
$135.07
|
| Rate for Payer: Blue Shield of California Commercial |
$437.02
|
| Rate for Payer: Blue Shield of California Commercial |
$204.22
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cigna of CA HMO |
$401.28
|
| Rate for Payer: Cigna of CA HMO |
$187.52
|
| Rate for Payer: Cigna of CA PPO |
$216.82
|
| Rate for Payer: Cigna of CA PPO |
$463.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$438.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.70
|
| Rate for Payer: EPIC Health Plan Senior |
$63.80
|
| Rate for Payer: EPIC Health Plan Senior |
$63.80
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Galaxy Health WC |
$532.95
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Global Benefits Group Commercial |
$376.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$95.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: Networks By Design Commercial |
$407.55
|
| Rate for Payer: Networks By Design Commercial |
$190.45
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: Prime Health Services Commercial |
$532.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$376.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$376.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO |
$46.98
|
| Rate for Payer: United Healthcare HMO Rider |
$46.98
|
| Rate for Payer: United Healthcare HMO Rider |
$46.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$1,107.24 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| 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 Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Blue Shield of California Commercial |
$453.62
|
| Rate for Payer: Blue Shield of California Commercial |
$100.04
|
| Rate for Payer: Blue Shield of California Commercial |
$685.85
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| 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 All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| 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 Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$580.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC HLA - B27
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903901903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$196.40 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: Adventist Health Commercial |
$196.40
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$687.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.80
|
| Rate for Payer: EPIC Health Plan Senior |
$392.80
|
| Rate for Payer: Galaxy Health WC |
$834.70
|
| Rate for Payer: Global Benefits Group Commercial |
$589.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$623.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.68
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: Networks By Design Commercial |
$638.30
|
| Rate for Payer: Prime Health Services Commercial |
$834.70
|
|
|
HC HLA - B27
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903901903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$1,247.05 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Adventist Health Commercial |
$196.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$676.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$676.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| 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 Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.05
|
| Rate for Payer: Blue Shield of California Commercial |
$452.70
|
| Rate for Payer: Blue Shield of California Commercial |
$150.29
|
| Rate for Payer: Blue Shield of California Commercial |
$684.45
|
| Rate for Payer: Blue Shield of California Commercial |
$227.22
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna of CA HMO |
$628.48
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Cigna of CA PPO |
$726.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$687.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.26
|
| Rate for Payer: EPIC Health Plan Senior |
$140.17
|
| Rate for Payer: EPIC Health Plan Senior |
$140.17
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Galaxy Health WC |
$834.70
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Global Benefits Group Commercial |
$589.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.26
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$623.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$638.30
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Prime Health Services Commercial |
$834.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$589.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| 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 All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$127.43
|
| 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 Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA B MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$580.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC HLA B MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$1,107.24 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| 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 Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,107.24
|
| Rate for Payer: Blue Shield of California Commercial |
$453.62
|
| Rate for Payer: Blue Shield of California Commercial |
$100.04
|
| Rate for Payer: Blue Shield of California Commercial |
$685.85
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.68
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| 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 All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| 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 Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA C1Q I
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$834.28 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| 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 Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.28
|
| Rate for Payer: Blue Shield of California Commercial |
$426.43
|
| Rate for Payer: Blue Shield of California Commercial |
$373.41
|
| Rate for Payer: Blue Shield of California Commercial |
$644.73
|
| Rate for Payer: Blue Shield of California Commercial |
$564.57
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| 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 Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| 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 Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| 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 Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA C1Q I
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913205
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| 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 C1Q I
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913205
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$834.28 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| 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 Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.28
|
| Rate for Payer: Blue Shield of California Commercial |
$426.43
|
| Rate for Payer: Blue Shield of California Commercial |
$373.41
|
| Rate for Payer: Blue Shield of California Commercial |
$644.73
|
| Rate for Payer: Blue Shield of California Commercial |
$564.57
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| 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 Medi-Cal |
$407.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| 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 Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| 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 Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA C1Q I
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913205
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| 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 C1Q II
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913206
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| 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 C1Q II
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$758.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| 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 Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.40
|
| Rate for Payer: Blue Shield of California Commercial |
$426.43
|
| Rate for Payer: Blue Shield of California Commercial |
$362.35
|
| Rate for Payer: Blue Shield of California Commercial |
$644.73
|
| Rate for Payer: Blue Shield of California Commercial |
$547.84
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.64
|
| 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 Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| 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 Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| 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 Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA C1Q II
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$758.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$754.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| 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 Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.40
|
| Rate for Payer: Blue Shield of California Commercial |
$426.43
|
| Rate for Payer: Blue Shield of California Commercial |
$362.35
|
| Rate for Payer: Blue Shield of California Commercial |
$644.73
|
| Rate for Payer: Blue Shield of California Commercial |
$547.84
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.25
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.64
|
| 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 Medi-Cal |
$410.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| 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 Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| 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 Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA C1Q II
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913206
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| 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 CELL STORAGE
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901971
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$49.79
|
| Rate for Payer: Blue Shield of California Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.00
|
| Rate for Payer: United Healthcare All Other HMO |
$54.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
HC HLA CELL STORAGE
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901971
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC HLA C MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901990
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$836.40 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$580.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.16
|
| Rate for Payer: Multiplan Commercial |
$787.20
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
