|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$91.05
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Senior |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: InnovAge PACE Commercial |
$57.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM LEGIONELLA AB
|
Facility
|
IP
|
$14.90
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$13.41 |
| Rate for Payer: Adventist Health Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Central Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.96
|
| Rate for Payer: EPIC Health Plan Senior |
$5.96
|
| Rate for Payer: Galaxy Health WC |
$12.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$9.69
|
| Rate for Payer: Prime Health Services Commercial |
$12.66
|
|
|
HC SOM LEGIONELLA AB
|
Facility
|
OP
|
$14.90
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$109.71 |
| Rate for Payer: Adventist Health Commercial |
$2.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$5.92
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Central Health Plan Commercial |
$11.92
|
| Rate for Payer: Cigna of CA HMO |
$9.54
|
| Rate for Payer: Cigna of CA PPO |
$11.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$12.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: InnovAge PACE Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$9.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$12.66
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Riverside University Health System MISP |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
|
OP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$9.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.38
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$11.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: InnovAge PACE Commercial |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.07
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC SOM LEGIONELLA PCR
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
900915470
|
|
Hospital Revenue Code
|
300
|
| 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 LEGIONELLA PCR
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
900915470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$255.17 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$70.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.79
|
| 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 |
$105.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.77
|
| Rate for Payer: EPIC Health Plan Senior |
$70.20
|
| 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 |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.20
|
| Rate for Payer: InnovAge PACE Commercial |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.07
|
| 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 |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$74.41
|
| Rate for Payer: Riverside University Health System MISP |
$77.22
|
| 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 |
$56.86
|
| Rate for Payer: United Healthcare All Other HMO |
$56.86
|
| Rate for Payer: United Healthcare HMO Rider |
$56.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Vantage Medical Group Senior |
$70.20
|
|
|
HC SOM LEPTOSPIRA IGM
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| 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 LEPTOSPIRA IGM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$62.49 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.68
|
| 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 |
$24.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.20
|
| 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 |
$26.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.20
|
| Rate for Payer: InnovAge PACE Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.71
|
| 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 |
$16.20
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$17.17
|
| Rate for Payer: Riverside University Health System MISP |
$17.82
|
| 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 |
$13.12
|
| Rate for Payer: United Healthcare All Other HMO |
$13.12
|
| Rate for Payer: United Healthcare HMO Rider |
$13.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Vantage Medical Group Senior |
$16.20
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$14.50
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.32
|
| Rate for Payer: Global Benefits Group Commercial |
$8.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.32
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$14.50
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$57.99 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.80
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$11.60
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$10.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$12.32
|
| Rate for Payer: Global Benefits Group Commercial |
$8.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$12.32
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Riverside University Health System MISP |
$14.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LIPASE BF
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
|
|
HC SOM LIPASE BF
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: InnovAge PACE Commercial |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$7.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
|
IP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$60.39 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$53.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.84
|
| Rate for Payer: EPIC Health Plan Senior |
$26.84
|
| Rate for Payer: Galaxy Health WC |
$57.03
|
| Rate for Payer: Global Benefits Group Commercial |
$40.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$50.33
|
| Rate for Payer: Networks By Design Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$57.03
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
|
OP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$60.39 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.73
|
| Rate for Payer: Blue Shield of California EPN |
$26.64
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$53.68
|
| Rate for Payer: Cigna of CA HMO |
$42.94
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$57.03
|
| Rate for Payer: Global Benefits Group Commercial |
$40.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: InnovAge PACE Commercial |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$50.33
|
| Rate for Payer: Networks By Design Commercial |
$43.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$57.03
|
| Rate for Payer: Prime Health Services Medicare |
$7.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
|
IP
|
$14.65
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$13.19 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Central Health Plan Commercial |
$11.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$12.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$10.99
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$12.45
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
|
OP
|
$14.65
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$92.13 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Central Health Plan Commercial |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$9.38
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Senior |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$12.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.32
|
| Rate for Payer: InnovAge PACE Commercial |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$10.99
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.32
|
| Rate for Payer: Prime Health Services Commercial |
$12.45
|
| Rate for Payer: Prime Health Services Medicare |
$15.18
|
| Rate for Payer: Riverside University Health System MISP |
$15.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.60
|
| Rate for Payer: United Healthcare All Other HMO |
$11.60
|
| Rate for Payer: United Healthcare HMO Rider |
$11.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$157.12 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.89
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.91
|
| Rate for Payer: EPIC Health Plan Senior |
$15.49
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.49
|
| Rate for Payer: InnovAge PACE Commercial |
$23.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.76
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.42
|
| Rate for Payer: Riverside University Health System MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
|
HC SOM LYME DISEASE AB IGM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$157.12 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.89
|
| Rate for Payer: Blue Shield of California Commercial |
$9.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.91
|
| Rate for Payer: EPIC Health Plan Senior |
$15.49
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.49
|
| Rate for Payer: InnovAge PACE Commercial |
$23.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.76
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.42
|
| Rate for Payer: Riverside University Health System MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
|
HC SOM LYME DISEASE AB IGM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$117.20 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.79
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$6.47
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Central Health Plan Commercial |
$13.04
|
| Rate for Payer: Cigna of CA HMO |
$10.43
|
| Rate for Payer: Cigna of CA PPO |
$12.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.99
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.03
|
| Rate for Payer: InnovAge PACE Commercial |
$25.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.03
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
| Rate for Payer: Prime Health Services Medicare |
$18.05
|
| Rate for Payer: Riverside University Health System MISP |
$18.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Central Health Plan Commercial |
$13.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$6.52
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
