|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$137.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.72
|
| Rate for Payer: Blue Shield of California Commercial |
$45.52
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: InnovAge PACE Commercial |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$145.22
|
| Rate for Payer: Riverside University Health System MISP |
$150.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$137.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.72
|
| Rate for Payer: Blue Shield of California Commercial |
$123.59
|
| Rate for Payer: Blue Shield of California EPN |
$80.83
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Central Health Plan Commercial |
$162.89
|
| Rate for Payer: Cigna of CA HMO |
$130.31
|
| Rate for Payer: Cigna of CA PPO |
$150.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: InnovAge PACE Commercial |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
| Rate for Payer: Prime Health Services Medicare |
$145.22
|
| Rate for Payer: Riverside University Health System MISP |
$150.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$183.25 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Central Health Plan Commercial |
$162.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.44
|
| Rate for Payer: EPIC Health Plan Senior |
$81.44
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.72
|
| Rate for Payer: Multiplan Commercial |
$152.71
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
IP
|
$47.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$43.16 |
| Rate for Payer: Adventist Health Commercial |
$9.59
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Central Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.18
|
| Rate for Payer: EPIC Health Plan Senior |
$19.18
|
| Rate for Payer: Galaxy Health WC |
$40.76
|
| Rate for Payer: Global Benefits Group Commercial |
$28.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Multiplan Commercial |
$35.96
|
| Rate for Payer: Networks By Design Commercial |
$31.17
|
| Rate for Payer: Prime Health Services Commercial |
$40.76
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
OP
|
$47.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$9.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$29.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.04
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Central Health Plan Commercial |
$38.36
|
| Rate for Payer: Cigna of CA HMO |
$30.69
|
| Rate for Payer: Cigna of CA PPO |
$35.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$40.76
|
| Rate for Payer: Global Benefits Group Commercial |
$28.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$35.96
|
| Rate for Payer: Networks By Design Commercial |
$31.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$40.76
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM DULOX 80299
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$105.94 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$27.70
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Central Health Plan Commercial |
$36.50
|
| Rate for Payer: Cigna of CA HMO |
$29.20
|
| Rate for Payer: Cigna of CA PPO |
$33.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$38.79
|
| Rate for Payer: Global Benefits Group Commercial |
$27.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$34.22
|
| Rate for Payer: Networks By Design Commercial |
$29.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$38.79
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM DULOX 80299
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Central Health Plan Commercial |
$36.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$18.25
|
| Rate for Payer: Galaxy Health WC |
$38.79
|
| Rate for Payer: Global Benefits Group Commercial |
$27.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$34.22
|
| Rate for Payer: Networks By Design Commercial |
$29.66
|
| Rate for Payer: Prime Health Services Commercial |
$38.79
|
|
|
HC SOM EBV PCR QUANT
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM EBV PCR QUANT
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.53
|
| 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 |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.51
|
| Rate for Payer: Blue Shield of California EPN |
$19.96
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| 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: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| 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: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| 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 |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| 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 ECHINOCOCCUS AB
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: InnovAge PACE Commercial |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.01
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Riverside University Health System MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM ECHINOCOCCUS AB
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM EHRLICHOSIS
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM EHRLICHOSIS
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$73.96 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| 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 |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| 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 |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| 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 |
$23.34
|
| 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 |
$7.00
|
| 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 |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| 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 |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| 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 ELECTROPHORES,PROTEN,RANDM
|
Facility
|
OP
|
$20.05
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Adventist Health Commercial |
$4.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.79
|
| Rate for Payer: Blue Shield of California Commercial |
$12.17
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Central Health Plan Commercial |
$16.04
|
| Rate for Payer: Cigna of CA HMO |
$12.83
|
| Rate for Payer: Cigna of CA PPO |
$14.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$17.04
|
| Rate for Payer: Global Benefits Group Commercial |
$12.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: InnovAge PACE Commercial |
$26.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$15.04
|
| Rate for Payer: Networks By Design Commercial |
$13.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.83
|
| Rate for Payer: Prime Health Services Commercial |
$17.04
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM ELECTROPHORES,PROTEN,RANDM
|
Facility
|
IP
|
$20.05
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Adventist Health Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Central Health Plan Commercial |
$16.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Senior |
$8.02
|
| Rate for Payer: Galaxy Health WC |
$17.04
|
| Rate for Payer: Global Benefits Group Commercial |
$12.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$15.04
|
| Rate for Payer: Networks By Design Commercial |
$13.03
|
| Rate for Payer: Prime Health Services Commercial |
$17.04
|
|
|
HC SOM ENC AGNA-1, CSF
|
Facility
|
OP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.10
|
| Rate for Payer: Blue Shield of California EPN |
$15.11
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Central Health Plan Commercial |
$30.45
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.35
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.35
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC AGNA-1, CSF
|
Facility
|
IP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$34.25 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Central Health Plan Commercial |
$30.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.22
|
| Rate for Payer: Galaxy Health WC |
$32.35
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.74
|
| Rate for Payer: Prime Health Services Commercial |
$32.35
|
|
|
HC SOM ENC AMPA-R AB CBA, CSF
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Central Health Plan Commercial |
$30.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.23
|
| Rate for Payer: EPIC Health Plan Senior |
$15.23
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
|
|
HC SOM ENC AMPA-R AB CBA, CSF
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.11
|
| Rate for Payer: Blue Shield of California EPN |
$15.11
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Central Health Plan Commercial |
$30.46
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC AMPHYIPHYSIN AB, CSF
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Central Health Plan Commercial |
$30.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.23
|
| Rate for Payer: EPIC Health Plan Senior |
$15.23
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
|
|
HC SOM ENC AMPHYIPHYSIN AB, CSF
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.11
|
| Rate for Payer: Blue Shield of California EPN |
$15.11
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Central Health Plan Commercial |
$30.46
|
| Rate for Payer: Cigna of CA HMO |
$24.36
|
| Rate for Payer: Cigna of CA PPO |
$28.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$32.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.36
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC ANNA-1, CSF
|
Facility
|
IP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915404
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$34.25 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Central Health Plan Commercial |
$30.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: EPIC Health Plan Senior |
$15.22
|
| Rate for Payer: Galaxy Health WC |
$32.35
|
| Rate for Payer: Global Benefits Group Commercial |
$22.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: Networks By Design Commercial |
$24.74
|
| Rate for Payer: Prime Health Services Commercial |
$32.35
|
|
