|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.05
|
| Rate for Payer: Blue Shield of California Commercial |
$32.19
|
| Rate for Payer: Blue Shield of California EPN |
$20.29
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Central Health Plan Commercial |
$40.88
|
| Rate for Payer: Cigna of CA HMO |
$32.70
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.85
|
| Rate for Payer: EPIC Health Plan Senior |
$25.23
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.94
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
| Rate for Payer: Prime Health Services Medicare |
$24.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$141.37 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.16
|
| Rate for Payer: Blue Shield of California Commercial |
$17.08
|
| Rate for Payer: Blue Shield of California EPN |
$10.76
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.73
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.11
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM VPHIV 87900
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$156.87 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.72
|
| Rate for Payer: EPIC Health Plan Senior |
$69.72
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.86
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: Networks By Design Commercial |
$113.30
|
| Rate for Payer: Prime Health Services Commercial |
$148.16
|
|
|
HC SOM VPHIV 87900
|
Facility
|
OP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$1,289.56 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$956.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$927.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.56
|
| Rate for Payer: Blue Shield of California Commercial |
$109.81
|
| Rate for Payer: Blue Shield of California EPN |
$69.20
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.44
|
| Rate for Payer: Cigna of CA HMO |
$111.55
|
| Rate for Payer: Cigna of CA PPO |
$128.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.08
|
| Rate for Payer: EPIC Health Plan Senior |
$143.38
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$213.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$220.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.67
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: Networks By Design Commercial |
$113.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.35
|
| Rate for Payer: Prime Health Services Commercial |
$148.16
|
| Rate for Payer: Prime Health Services Medicare |
$138.17
|
| Rate for Payer: Riverside University Health System MISP |
$143.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.59
|
| Rate for Payer: United Healthcare All Other HMO |
$105.59
|
| Rate for Payer: United Healthcare HMO Rider |
$105.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Vantage Medical Group Senior |
$130.35
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Central Health Plan Commercial |
$22.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11.27
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$17.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Central Health Plan Commercial |
$22.54
|
| Rate for Payer: Cigna of CA HMO |
$18.03
|
| Rate for Payer: Cigna of CA PPO |
$20.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Central Health Plan Commercial |
$22.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11.27
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$5.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$17.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.18
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Central Health Plan Commercial |
$22.54
|
| Rate for Payer: Cigna of CA HMO |
$18.03
|
| Rate for Payer: Cigna of CA PPO |
$20.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$23.94
|
| Rate for Payer: Global Benefits Group Commercial |
$16.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$21.13
|
| Rate for Payer: Networks By Design Commercial |
$18.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$23.94
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$166.68 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.68
|
| Rate for Payer: Blue Shield of California Commercial |
$11.58
|
| Rate for Payer: Blue Shield of California EPN |
$7.30
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$13.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Riverside University Health System MISP |
$18.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
IP
|
$18.38
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.35
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
OP
|
$18.38
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.38
|
| Rate for Payer: Blue Shield of California Commercial |
$11.58
|
| Rate for Payer: Blue Shield of California EPN |
$7.30
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: Central Health Plan Commercial |
$14.70
|
| Rate for Payer: Cigna of CA HMO |
$11.76
|
| Rate for Payer: Cigna of CA PPO |
$13.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$15.62
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$21.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Central Health Plan Commercial |
$17.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.38
|
| Rate for Payer: Blue Shield of California Commercial |
$13.56
|
| Rate for Payer: Blue Shield of California EPN |
$8.54
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Central Health Plan Commercial |
$17.22
|
| Rate for Payer: Cigna of CA HMO |
$13.77
|
| Rate for Payer: Cigna of CA PPO |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
IP
|
$21.52
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Central Health Plan Commercial |
$17.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.61
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$166.68 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.68
|
| Rate for Payer: Blue Shield of California Commercial |
$13.56
|
| Rate for Payer: Blue Shield of California EPN |
$8.54
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Central Health Plan Commercial |
$17.22
|
| Rate for Payer: Cigna of CA HMO |
$13.77
|
| Rate for Payer: Cigna of CA PPO |
$15.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$18.29
|
| Rate for Payer: Global Benefits Group Commercial |
$12.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$16.14
|
| Rate for Payer: Networks By Design Commercial |
$13.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$18.29
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Riverside University Health System MISP |
$18.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$57.96
|
| Rate for Payer: Blue Shield of California EPN |
$36.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Central Health Plan Commercial |
$73.60
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM WHEY IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM WHEY IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
IP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.93 |
| Max. Negotiated Rate |
$202.19 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Central Health Plan Commercial |
$179.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.86
|
| Rate for Payer: EPIC Health Plan Senior |
$89.86
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.93
|
| Rate for Payer: Multiplan Commercial |
$168.49
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
OP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$202.19 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$141.53
|
| Rate for Payer: Blue Shield of California EPN |
$89.19
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Central Health Plan Commercial |
$179.72
|
| Rate for Payer: Cigna of CA HMO |
$143.78
|
| Rate for Payer: Cigna of CA PPO |
$166.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$168.49
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
