|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM ARYLSULFATASE A, URINE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900910723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$75.88
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: InnovAge PACE Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM ASPERGILLUS AG BAL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900915471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM ASPERGILLUS AG BAL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900915471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.42
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.42
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM ASPERGILLUS(GALACT)ANTIGEN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 87305
|
| Hospital Charge Code |
900912574
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM ATIVAN
|
Facility
|
OP
|
$73.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$129.05 |
| Rate for Payer: Adventist Health Commercial |
$14.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.19
|
| Rate for Payer: Blue Shield of California Commercial |
$44.67
|
| Rate for Payer: Blue Shield of California EPN |
$29.22
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Central Health Plan Commercial |
$58.87
|
| Rate for Payer: Cigna of CA HMO |
$47.10
|
| Rate for Payer: Cigna of CA PPO |
$54.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.44
|
| Rate for Payer: EPIC Health Plan Senior |
$29.44
|
| Rate for Payer: Galaxy Health WC |
$62.55
|
| Rate for Payer: Global Benefits Group Commercial |
$44.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.23
|
| Rate for Payer: InnovAge PACE Commercial |
$36.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.51
|
| Rate for Payer: Multiplan Commercial |
$55.19
|
| Rate for Payer: Networks By Design Commercial |
$47.83
|
| Rate for Payer: Prime Health Services Commercial |
$62.55
|
| Rate for Payer: Riverside University Health System MISP |
$29.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.80
|
| Rate for Payer: United Healthcare All Other HMO |
$36.80
|
| Rate for Payer: United Healthcare HMO Rider |
$36.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.55
|
| Rate for Payer: Vantage Medical Group Senior |
$62.55
|
|
|
HC SOM ATIVAN
|
Facility
|
IP
|
$73.59
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$66.23 |
| Rate for Payer: Adventist Health Commercial |
$14.72
|
| Rate for Payer: Cash Price |
$73.59
|
| Rate for Payer: Central Health Plan Commercial |
$58.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.44
|
| Rate for Payer: EPIC Health Plan Senior |
$29.44
|
| Rate for Payer: Galaxy Health WC |
$62.55
|
| Rate for Payer: Global Benefits Group Commercial |
$44.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.72
|
| Rate for Payer: Multiplan Commercial |
$55.19
|
| Rate for Payer: Networks By Design Commercial |
$47.83
|
| Rate for Payer: Prime Health Services Commercial |
$62.55
|
|
|
HC SOM BACLOFEN 83789
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$193.63
|
| Rate for Payer: Blue Shield of California EPN |
$126.64
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$255.20
|
| Rate for Payer: Cigna of CA HMO |
$204.16
|
| Rate for Payer: Cigna of CA PPO |
$236.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Senior |
$24.11
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: InnovAge PACE Commercial |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.11
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM BACLOFEN 83789
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900915259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.60
|
| Rate for Payer: EPIC Health Plan Senior |
$127.60
|
| Rate for Payer: Galaxy Health WC |
$271.15
|
| Rate for Payer: Global Benefits Group Commercial |
$191.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$287.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.80
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: Networks By Design Commercial |
$207.35
|
| Rate for Payer: Prime Health Services Commercial |
$271.15
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
|
IP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$55.12 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Central Health Plan Commercial |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.50
|
| Rate for Payer: EPIC Health Plan Senior |
$24.50
|
| Rate for Payer: Galaxy Health WC |
$52.06
|
| Rate for Payer: Global Benefits Group Commercial |
$36.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: Networks By Design Commercial |
$39.81
|
| Rate for Payer: Prime Health Services Commercial |
$52.06
|
|
|
HC SOM BARBITURATE CONFIRM, U
|
Facility
|
OP
|
$61.25
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900912916
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$79.93 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.22
|
| Rate for Payer: Blue Shield of California Commercial |
$37.18
|
| Rate for Payer: Blue Shield of California EPN |
$24.32
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Central Health Plan Commercial |
$49.00
|
| Rate for Payer: Cigna of CA HMO |
$39.20
|
| Rate for Payer: Cigna of CA PPO |
$45.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.50
|
| Rate for Payer: EPIC Health Plan Senior |
$24.50
|
| Rate for Payer: Galaxy Health WC |
$52.06
|
| Rate for Payer: Global Benefits Group Commercial |
$36.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.12
|
| Rate for Payer: InnovAge PACE Commercial |
$30.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.88
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: Networks By Design Commercial |
$39.81
|
| Rate for Payer: Prime Health Services Commercial |
$52.06
|
| Rate for Payer: Riverside University Health System MISP |
$24.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.62
|
| Rate for Payer: United Healthcare All Other HMO |
$30.62
|
| Rate for Payer: United Healthcare HMO Rider |
$30.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.06
|
| Rate for Payer: Vantage Medical Group Senior |
$52.06
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$73.96 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.90
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$7.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA HENSELAE AB IGG
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900911386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$73.96 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.90
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$7.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA HENSELAE AB IGM
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912690
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
|
|
HC SOM BARTONELLA QUINTANA AB IGG
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912691
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$73.96 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.90
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$7.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
|
|
HC SOM BARTONELLA QUINTANA AB IGM
|
Facility
|
OP
|
$9.83
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
900912692
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$73.96 |
| Rate for Payer: Adventist Health Commercial |
$1.97
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.90
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Central Health Plan Commercial |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$7.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$8.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$7.37
|
| Rate for Payer: Networks By Design Commercial |
$6.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.36
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
OP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$229.05 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$154.48
|
| Rate for Payer: Blue Shield of California EPN |
$101.04
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Central Health Plan Commercial |
$203.60
|
| Rate for Payer: Cigna of CA HMO |
$162.88
|
| Rate for Payer: Cigna of CA PPO |
$188.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Senior |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.32
|
| Rate for Payer: Global Benefits Group Commercial |
$152.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$127.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.15
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: Networks By Design Commercial |
$165.43
|
| Rate for Payer: Prime Health Services Commercial |
$216.32
|
| Rate for Payer: Riverside University Health System MISP |
$101.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.32
|
| Rate for Payer: Vantage Medical Group Senior |
$216.32
|
|
|
HC SOM B-CELL LYMPH FISH INTERP
|
Facility
|
IP
|
$254.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914116
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$229.05 |
| Rate for Payer: Adventist Health Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Central Health Plan Commercial |
$203.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.80
|
| Rate for Payer: EPIC Health Plan Senior |
$101.80
|
| Rate for Payer: Galaxy Health WC |
$216.32
|
| Rate for Payer: Global Benefits Group Commercial |
$152.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$157.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.90
|
| Rate for Payer: Multiplan Commercial |
$190.88
|
| Rate for Payer: Networks By Design Commercial |
$165.43
|
| Rate for Payer: Prime Health Services Commercial |
$216.32
|
|
|
HC SOM BCR/ABL1, P190, MRNA DETECTION, RT-PCR, QUANTITATIVE, MONITORING ASSAY
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
900915426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.63 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$144.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.63
|
| Rate for Payer: Blue Shield of California Commercial |
$212.45
|
| Rate for Payer: Blue Shield of California EPN |
$138.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.84
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.84
|
| Rate for Payer: InnovAge PACE Commercial |
$217.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$194.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$194.09
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$144.84
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$153.53
|
| Rate for Payer: Riverside University Health System MISP |
$159.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.32
|
| Rate for Payer: United Healthcare All Other HMO |
$117.32
|
| Rate for Payer: United Healthcare HMO Rider |
$117.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.32
|
| Rate for Payer: Vantage Medical Group Senior |
$144.84
|
|
|
HC SOM BCR/ABL1, P190, MRNA DETECTION, RT-PCR, QUANTITATIVE, MONITORING ASSAY
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
900915426
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM BCR ABL MUTAT ASPE
|
Facility
|
IP
|
$435.08
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914536
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$391.57 |
| Rate for Payer: Adventist Health Commercial |
$87.02
|
| Rate for Payer: Cash Price |
$435.08
|
| Rate for Payer: Central Health Plan Commercial |
$348.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.03
|
| Rate for Payer: EPIC Health Plan Senior |
$174.03
|
| Rate for Payer: Galaxy Health WC |
$369.82
|
| Rate for Payer: Global Benefits Group Commercial |
$261.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.02
|
| Rate for Payer: Multiplan Commercial |
$326.31
|
| Rate for Payer: Networks By Design Commercial |
$282.80
|
| Rate for Payer: Prime Health Services Commercial |
$369.82
|
|
