|
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: Cash Price |
$6.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$107.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: AlphaCare 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 |
$107.41
|
| Rate for Payer: BCBS Transplant Transplant |
$9.07
|
| Rate for Payer: Blue Shield of California Commercial |
$9.34
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Caremore Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cash Price |
$6.80
|
| 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: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: IEHP medi-cal |
$19.98
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$12.84
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.07
|
| Rate for Payer: Riverside University Health 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: 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
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: Cash Price |
$9.13
|
| Rate for Payer: Central Health Plan Commercial |
$16.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$143.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: AlphaCare 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 |
$143.61
|
| Rate for Payer: BCBS Transplant Transplant |
$12.17
|
| Rate for Payer: Blue Shield of California Commercial |
$12.53
|
| Rate for Payer: Blue Shield of California EPN |
$9.86
|
| Rate for Payer: Caremore Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$9.13
|
| Rate for Payer: Cash Price |
$9.13
|
| 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: EPIC Health Plan Commercial |
$21.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$15.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.67
|
| Rate for Payer: IEHP medi-cal |
$26.83
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$17.24
|
| Rate for Payer: Prime Health Services Medicare |
$17.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.17
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$8.06
|
| Rate for Payer: Central Health Plan Commercial |
$14.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$149.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: AlphaCare 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 |
$149.59
|
| Rate for Payer: BCBS Transplant Transplant |
$10.75
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California EPN |
$8.71
|
| Rate for Payer: Caremore Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| 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: EPIC Health Plan Commercial |
$24.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.39
|
| Rate for Payer: IEHP medi-cal |
$29.57
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$15.23
|
| Rate for Payer: Prime Health Services Medicare |
$19.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.75
|
| Rate for Payer: Riverside University Health 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: 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
OP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$249.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare 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 |
$233.58
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| 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 |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| 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: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
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: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 H PYLORI WITH CLARITHO RESISTANCE PCR
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SOM H PYLORI WITH CLARITHO RESISTANCE PCR
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare 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 |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.00
|
| Rate for Payer: Blue Shield of California EPN |
$243.00
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$375.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| 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 |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
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: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$2,718.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$220.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$247.20
|
| Rate for Payer: Blue Shield of California EPN |
$194.40
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| 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: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$300.00
|
| Rate for Payer: IEHP medi-cal |
$140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: Riverside University Health 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 |
$2,718.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
IP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$27.87 |
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Central Health Plan Commercial |
$24.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.19
|
| Rate for Payer: Multiplan Commercial |
$23.23
|
| Rate for Payer: Networks By Design Commercial |
$20.13
|
| Rate for Payer: Prime Health Services Commercial |
$26.32
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
OP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$18.58
|
| Rate for Payer: Blue Shield of California Commercial |
$19.14
|
| Rate for Payer: Blue Shield of California EPN |
$15.05
|
| Rate for Payer: Caremore Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Central Health Plan Commercial |
$24.78
|
| Rate for Payer: Cigna of CA HMO |
$19.82
|
| Rate for Payer: Cigna of CA PPO |
$22.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.87
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: IEHP medi-cal |
$21.76
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Innovage PACE Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$23.23
|
| Rate for Payer: Networks By Design Commercial |
$20.13
|
| Rate for Payer: Prime Health Services Commercial |
$26.32
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.58
|
| Rate for Payer: Riverside University Health MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
OP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$171.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.63
|
| Rate for Payer: BCBS Transplant Transplant |
$27.27
|
| Rate for Payer: Blue Shield of California Commercial |
$28.09
|
| Rate for Payer: Blue Shield of California EPN |
$22.09
|
| Rate for Payer: Caremore Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$20.45
|
| Rate for Payer: Cash Price |
$20.45
|
| Rate for Payer: Central Health Plan Commercial |
$36.36
|
| Rate for Payer: Cigna of CA HMO |
$29.09
|
| Rate for Payer: Cigna of CA PPO |
$33.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$34.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: IEHP medi-cal |
$31.93
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Innovage PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$34.09
|
| Rate for Payer: Networks By Design Commercial |
$29.54
|
| Rate for Payer: Prime Health Services Commercial |
$38.63
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.27
|
| Rate for Payer: Riverside University Health MISP |
$21.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
IP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Cash Price |
$20.45
|
| Rate for Payer: Central Health Plan Commercial |
$36.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.18
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$34.09
|
| Rate for Payer: Networks By Design Commercial |
$29.54
|
| Rate for Payer: Prime Health Services Commercial |
$38.63
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
IP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Central Health Plan Commercial |
$9.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
OP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$7.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.71
|
| Rate for Payer: Caremore Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Cash Price |
$5.29
|
| Rate for Payer: Central Health Plan Commercial |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$8.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.58
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: IEHP medi-cal |
$21.76
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Innovage PACE Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.05
|
| Rate for Payer: Riverside University Health MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
IP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Central Health Plan Commercial |
$13.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.66
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
OP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$171.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.63
|
| Rate for Payer: BCBS Transplant Transplant |
$10.35
|
| Rate for Payer: Blue Shield of California Commercial |
$10.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.38
|
| Rate for Payer: Caremore Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Central Health Plan Commercial |
$13.80
|
| Rate for Payer: Cigna of CA HMO |
$11.04
|
| Rate for Payer: Cigna of CA PPO |
$12.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: IEHP medi-cal |
$31.93
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Innovage PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.66
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.35
|
| Rate for Payer: Riverside University Health MISP |
$21.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HTGFN 84432
|
Facility
OP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.35
|
| Rate for Payer: BCBS Transplant Transplant |
$98.33
|
| Rate for Payer: Blue Shield of California Commercial |
$101.28
|
| Rate for Payer: Blue Shield of California EPN |
$79.65
|
| Rate for Payer: Caremore Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Cigna of CA HMO |
$104.88
|
| Rate for Payer: Cigna of CA PPO |
$121.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$122.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.34
|
| Rate for Payer: IEHP medi-cal |
$26.50
|
| Rate for Payer: IEHP Medicare Advantage |
$16.06
|
| Rate for Payer: Innovage PACE Commercial |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: Riverside University Health MISP |
$17.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Vantage Medical Group Senior |
$16.06
|
|
|
HC SOM HTGFN 84432
|
Facility
IP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.75
|
| Rate for Payer: BCBS Transplant Transplant |
$78.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.34
|
| Rate for Payer: Blue Shield of California EPN |
$63.18
|
| Rate for Payer: Caremore Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.35
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$97.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: IEHP medi-cal |
$31.93
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Innovage PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: Riverside University Health MISP |
$21.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
IP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.95
|
|
