|
HC SOM HIV-2 ANTIBODY
|
Facility
|
OP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.28
|
| Rate for Payer: Blue Shield of California Commercial |
$27.46
|
| Rate for Payer: Blue Shield of California EPN |
$17.96
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Central Health Plan Commercial |
$36.19
|
| Rate for Payer: Cigna of CA HMO |
$28.95
|
| Rate for Payer: Cigna of CA PPO |
$33.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$38.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: InnovAge PACE Commercial |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
| Rate for Payer: Networks By Design Commercial |
$29.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: Prime Health Services Commercial |
$38.45
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.28
|
| Rate for Payer: Blue Shield of California Commercial |
$39.45
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: InnovAge PACE Commercial |
$20.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$188.22 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$85.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.89
|
| Rate for Payer: EPIC Health Plan Senior |
$85.10
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$139.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: InnovAge PACE Commercial |
$127.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$85.10
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$90.21
|
| Rate for Payer: Riverside University Health System MISP |
$93.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.93
|
| Rate for Payer: United Healthcare All Other HMO |
$68.93
|
| Rate for Payer: United Healthcare HMO Rider |
$68.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$85.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIVE 86703
|
Facility
|
IP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Central Health Plan Commercial |
$91.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.78
|
| Rate for Payer: EPIC Health Plan Senior |
$45.78
|
| Rate for Payer: Galaxy Health WC |
$97.28
|
| Rate for Payer: Global Benefits Group Commercial |
$68.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
| Rate for Payer: Networks By Design Commercial |
$74.39
|
| Rate for Payer: Prime Health Services Commercial |
$97.28
|
|
|
HC SOM HIVE 86703
|
Facility
|
OP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.86
|
| Rate for Payer: Blue Shield of California Commercial |
$69.47
|
| Rate for Payer: Blue Shield of California EPN |
$45.44
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Central Health Plan Commercial |
$91.56
|
| Rate for Payer: Cigna of CA HMO |
$73.25
|
| Rate for Payer: Cigna of CA PPO |
$84.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$97.28
|
| Rate for Payer: Global Benefits Group Commercial |
$68.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: InnovAge PACE Commercial |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
| Rate for Payer: Networks By Design Commercial |
$74.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.71
|
| Rate for Payer: Prime Health Services Commercial |
$97.28
|
| Rate for Payer: Prime Health Services Medicare |
$14.53
|
| Rate for Payer: Riverside University Health System MISP |
$15.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC SOM HMUCR ARSENIC/CREAT, RAND, U
|
Facility
|
IP
|
$23.66
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Adventist Health Commercial |
$4.73
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Central Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Senior |
$9.46
|
| Rate for Payer: Galaxy Health WC |
$20.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.73
|
| Rate for Payer: Multiplan Commercial |
$17.75
|
| Rate for Payer: Networks By Design Commercial |
$15.38
|
| Rate for Payer: Prime Health Services Commercial |
$20.11
|
|
|
HC SOM HMUCR ARSENIC/CREAT, RAND, U
|
Facility
|
OP
|
$23.66
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$138.02 |
| Rate for Payer: Adventist Health Commercial |
$4.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.01
|
| Rate for Payer: Blue Shield of California Commercial |
$14.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.39
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Central Health Plan Commercial |
$18.93
|
| Rate for Payer: Cigna of CA HMO |
$15.14
|
| Rate for Payer: Cigna of CA PPO |
$17.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.61
|
| Rate for Payer: EPIC Health Plan Senior |
$18.97
|
| Rate for Payer: Galaxy Health WC |
$20.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: InnovAge PACE Commercial |
$28.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$17.75
|
| Rate for Payer: Networks By Design Commercial |
$15.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$20.11
|
| Rate for Payer: Prime Health Services Medicare |
$20.11
|
| Rate for Payer: Riverside University Health System MISP |
$20.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO |
$15.36
|
| Rate for Payer: United Healthcare HMO Rider |
$15.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM HMUCR CADMIUM/CREAT, RAND, U
|
Facility
|
IP
|
$29.49
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900915365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$26.54 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Cash Price |
$29.49
|
| Rate for Payer: Central Health Plan Commercial |
$23.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.80
|
| Rate for Payer: Galaxy Health WC |
$25.07
|
| Rate for Payer: Global Benefits Group Commercial |
$17.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: Networks By Design Commercial |
$19.17
|
| Rate for Payer: Prime Health Services Commercial |
$25.07
|
|
|
HC SOM HMUCR CADMIUM/CREAT, RAND, U
|
Facility
|
OP
|
$29.49
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900915365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$168.28 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.15
|
| Rate for Payer: Blue Shield of California Commercial |
$17.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$29.49
|
| Rate for Payer: Cash Price |
$29.49
|
| Rate for Payer: Central Health Plan Commercial |
$23.59
|
| Rate for Payer: Cigna of CA HMO |
$18.87
|
| Rate for Payer: Cigna of CA PPO |
$21.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.91
|
| Rate for Payer: EPIC Health Plan Senior |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$25.07
|
| Rate for Payer: Global Benefits Group Commercial |
$17.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: InnovAge PACE Commercial |
$35.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: Networks By Design Commercial |
$19.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.64
|
| Rate for Payer: Prime Health Services Commercial |
$25.07
|
| Rate for Payer: Prime Health Services Medicare |
$25.06
|
| Rate for Payer: Riverside University Health System MISP |
$26.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.15
|
| Rate for Payer: United Healthcare All Other HMO |
$19.15
|
| Rate for Payer: United Healthcare HMO Rider |
$19.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM HMUCR CREATININE, RAND, U
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Central Health Plan Commercial |
$5.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.58
|
| Rate for Payer: EPIC Health Plan Senior |
$2.58
|
| Rate for Payer: Galaxy Health WC |
$5.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.49
|
|
|
HC SOM HMUCR CREATININE, RAND, U
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$1.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.92
|
| Rate for Payer: Blue Shield of California EPN |
$2.56
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Central Health Plan Commercial |
$5.17
|
| Rate for Payer: Cigna of CA HMO |
$4.13
|
| Rate for Payer: Cigna of CA PPO |
$4.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$5.49
|
| Rate for Payer: Global Benefits Group Commercial |
$3.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.84
|
| Rate for Payer: Networks By Design Commercial |
$4.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM HMUCR LEAD/CREAT, RAND, U
|
Facility
|
IP
|
$15.11
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900915367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Central Health Plan Commercial |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.84
|
| Rate for Payer: Global Benefits Group Commercial |
$9.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.33
|
| Rate for Payer: Networks By Design Commercial |
$9.82
|
| Rate for Payer: Prime Health Services Commercial |
$12.84
|
|
|
HC SOM HMUCR LEAD/CREAT, RAND, U
|
Facility
|
OP
|
$15.11
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900915367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$88.06 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9.17
|
| Rate for Payer: Blue Shield of California EPN |
$6.00
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Cash Price |
$15.11
|
| Rate for Payer: Central Health Plan Commercial |
$12.09
|
| Rate for Payer: Cigna of CA HMO |
$9.67
|
| Rate for Payer: Cigna of CA PPO |
$11.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$12.84
|
| Rate for Payer: Global Benefits Group Commercial |
$9.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: InnovAge PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$11.33
|
| Rate for Payer: Networks By Design Commercial |
$9.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.11
|
| Rate for Payer: Prime Health Services Commercial |
$12.84
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM HMUCR MERCURY/CREAT, RAND, U
|
Facility
|
OP
|
$20.28
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900915366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$117.74 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.31
|
| Rate for Payer: Blue Shield of California EPN |
$8.05
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Central Health Plan Commercial |
$16.22
|
| Rate for Payer: Cigna of CA HMO |
$12.98
|
| Rate for Payer: Cigna of CA PPO |
$15.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.95
|
| Rate for Payer: EPIC Health Plan Senior |
$16.26
|
| Rate for Payer: Galaxy Health WC |
$17.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: InnovAge PACE Commercial |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$15.21
|
| Rate for Payer: Networks By Design Commercial |
$13.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.26
|
| Rate for Payer: Prime Health Services Commercial |
$17.24
|
| Rate for Payer: Prime Health Services Medicare |
$17.24
|
| Rate for Payer: Riverside University Health System MISP |
$17.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.17
|
| Rate for Payer: United Healthcare All Other HMO |
$13.17
|
| Rate for Payer: United Healthcare HMO Rider |
$13.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM HMUCR MERCURY/CREAT, RAND, U
|
Facility
|
IP
|
$20.28
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900915366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Adventist Health Commercial |
$4.06
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Central Health Plan Commercial |
$16.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Senior |
$8.11
|
| Rate for Payer: Galaxy Health WC |
$17.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$15.21
|
| Rate for Payer: Networks By Design Commercial |
$13.18
|
| Rate for Payer: Prime Health Services Commercial |
$17.24
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
IP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.13 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Central Health Plan Commercial |
$14.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.17
|
| Rate for Payer: EPIC Health Plan Senior |
$7.17
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: Prime Health Services Commercial |
$15.23
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
OP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$122.64 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$10.88
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Central Health Plan Commercial |
$14.34
|
| Rate for Payer: Cigna of CA HMO |
$11.47
|
| Rate for Payer: Cigna of CA PPO |
$13.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.19
|
| Rate for Payer: EPIC Health Plan Senior |
$17.92
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.92
|
| Rate for Payer: InnovAge PACE Commercial |
$26.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.01
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.92
|
| Rate for Payer: Prime Health Services Commercial |
$15.23
|
| Rate for Payer: Prime Health Services Medicare |
$19.00
|
| Rate for Payer: Riverside University Health System MISP |
$19.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare HMO Rider |
$14.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Vantage Medical Group Senior |
$17.92
|
|
|
HC SOM HPV
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM HPV
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$191.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| 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 |
$191.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.87
|
| Rate for Payer: Blue Shield of California Commercial |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| 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 |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| 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 |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| 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 |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| 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 H PYLORI WITH CLARITHO RESISTANCE PCR
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.47
|
| 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 |
$288.32
|
| Rate for Payer: Blue Shield of California EPN |
$188.57
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: Cigna of CA HMO |
$304.00
|
| Rate for Payer: Cigna of CA PPO |
$351.50
|
| 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 |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| 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 |
$316.82
|
| 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 |
$95.00
|
| 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 |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
| 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 |
$285.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.00
|
| 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 H PYLORI WITH CLARITHO RESISTANCE PCR
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Central Health Plan Commercial |
$380.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.00
|
| Rate for Payer: EPIC Health Plan Senior |
$190.00
|
| Rate for Payer: Galaxy Health WC |
$403.75
|
| Rate for Payer: Global Benefits Group Commercial |
$285.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$427.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.00
|
| Rate for Payer: Multiplan Commercial |
$356.25
|
| Rate for Payer: Networks By Design Commercial |
$308.75
|
| Rate for Payer: Prime Health Services Commercial |
$403.75
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.58
|
| Rate for Payer: Blue Shield of California Commercial |
$242.80
|
| Rate for Payer: Blue Shield of California EPN |
$158.80
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: InnovAge PACE Commercial |
$200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
