|
HC SOM MMRV 86765
|
Facility
OP
|
$17.90
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900914956
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$15.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$11.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MMRV 86765
|
Facility
IP
|
$17.90
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900914956
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$11.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.22
|
|
|
HC SOM MMRV 86787
|
Facility
OP
|
$29.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900914959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$17.84
|
| Rate for Payer: Blue Shield of California Commercial |
$18.37
|
| Rate for Payer: Blue Shield of California EPN |
$14.45
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Central Health Plan Commercial |
$23.78
|
| Rate for Payer: Cigna of CA HMO |
$19.03
|
| Rate for Payer: Cigna of CA PPO |
$22.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$25.27
|
| Rate for Payer: Global Benefits Group Commercial |
$17.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$22.30
|
| Rate for Payer: Networks By Design Commercial |
$19.32
|
| Rate for Payer: Prime Health Services Commercial |
$25.27
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.84
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MMRV 86787
|
Facility
IP
|
$29.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900914959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Central Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: Galaxy Health WC |
$25.27
|
| Rate for Payer: Global Benefits Group Commercial |
$17.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$22.30
|
| Rate for Payer: Networks By Design Commercial |
$19.32
|
| Rate for Payer: Prime Health Services Commercial |
$25.27
|
|
|
HC SOM MONKEYPOX DNA PCR
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM MONKEYPOX DNA PCR
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$314.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$314.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.90
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.16
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: IEHP medi-cal |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.44
|
| Rate for Payer: United Healthcare All Other HMO |
$41.44
|
| Rate for Payer: United Healthcare HMO Rider |
$41.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SOM M PNEUMONIAE AB IGM S IFA
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900913940
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| 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 |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$29.05
|
| Rate for Payer: Blue Shield of California EPN |
$22.84
|
| Rate for Payer: Caremore Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$30.08
|
| Rate for Payer: Cigna of CA PPO |
$34.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: IEHP medi-cal |
$21.85
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Innovage PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: Riverside University Health MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM M PNEUMONIAE AB IGM S IFA
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900913940
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
|
|
HC SOM M PROTEIN MASS FIX
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 0077U
|
| Hospital Charge Code |
900915454
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$3,518.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$43.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$43.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$191.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.99
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$43.43
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| 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 |
$65.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.43
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.23
|
| Rate for Payer: IEHP medi-cal |
$71.66
|
| Rate for Payer: IEHP Medicare Advantage |
$43.43
|
| Rate for Payer: Innovage PACE Commercial |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.20
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$46.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$47.77
|
| 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 |
$35.18
|
| Rate for Payer: United Healthcare All Other HMO |
$35.18
|
| Rate for Payer: United Healthcare HMO Rider |
$35.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,518.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.77
|
| Rate for Payer: Vantage Medical Group Senior |
$43.43
|
|
|
HC SOM M PROTEIN MASS FIX
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 0077U
|
| Hospital Charge Code |
900915454
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 MTB PCR COMPLEX SPUTUM
|
Facility
IP
|
$243.39
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Cash Price |
$109.53
|
| Rate for Payer: Central Health Plan Commercial |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.36
|
| Rate for Payer: Galaxy Health WC |
$206.88
|
| Rate for Payer: Global Benefits Group Commercial |
$146.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.68
|
| Rate for Payer: Multiplan Commercial |
$182.54
|
| Rate for Payer: Networks By Design Commercial |
$158.20
|
| Rate for Payer: Prime Health Services Commercial |
$206.88
|
|
|
HC SOM MTB PCR COMPLEX SPUTUM
|
Facility
OP
|
$243.39
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$301.33 |
| 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 |
$146.03
|
| Rate for Payer: Blue Shield of California Commercial |
$150.42
|
| Rate for Payer: Blue Shield of California EPN |
$118.29
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$109.53
|
| Rate for Payer: Cash Price |
$109.53
|
| Rate for Payer: Central Health Plan Commercial |
$194.71
|
| Rate for Payer: Cigna of CA HMO |
$155.77
|
| Rate for Payer: Cigna of CA PPO |
$180.11
|
| 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 |
$206.88
|
| Rate for Payer: Global Benefits Group Commercial |
$146.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$182.54
|
| 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 |
$162.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.68
|
| 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 |
$182.54
|
| Rate for Payer: Networks By Design Commercial |
$158.20
|
| Rate for Payer: Prime Health Services Commercial |
$206.88
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$146.03
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.03
|
| 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 MTB PCR SPUTUM
|
Facility
OP
|
$289.11
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$41.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.68
|
| 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 |
$173.47
|
| Rate for Payer: Blue Shield of California Commercial |
$178.67
|
| Rate for Payer: Blue Shield of California EPN |
$140.51
|
| Rate for Payer: Caremore Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$130.10
|
| Rate for Payer: Cash Price |
$130.10
|
| Rate for Payer: Central Health Plan Commercial |
$231.29
|
| Rate for Payer: Cigna of CA HMO |
$185.03
|
| Rate for Payer: Cigna of CA PPO |
$213.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.68
|
| Rate for Payer: Galaxy Health WC |
$245.74
|
| Rate for Payer: Global Benefits Group Commercial |
$173.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$216.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.36
|
| Rate for Payer: IEHP medi-cal |
$68.77
|
| Rate for Payer: IEHP Medicare Advantage |
$41.68
|
| Rate for Payer: Innovage PACE Commercial |
$62.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$216.83
|
| Rate for Payer: Networks By Design Commercial |
$187.92
|
| Rate for Payer: Prime Health Services Commercial |
$245.74
|
| Rate for Payer: Prime Health Services Medicare |
$44.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$173.47
|
| Rate for Payer: Riverside University Health MISP |
$45.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOM MTB PCR SPUTUM
|
Facility
IP
|
$289.11
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$260.20 |
| Rate for Payer: Cash Price |
$130.10
|
| Rate for Payer: Central Health Plan Commercial |
$231.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: Galaxy Health WC |
$245.74
|
| Rate for Payer: Global Benefits Group Commercial |
$173.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.82
|
| Rate for Payer: Multiplan Commercial |
$216.83
|
| Rate for Payer: Networks By Design Commercial |
$187.92
|
| Rate for Payer: Prime Health Services Commercial |
$245.74
|
|
|
HC SOM MTHFR MUTATION DETECTION
|
Facility
OP
|
$190.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900914663
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$405.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$65.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$332.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.69
|
| Rate for Payer: BCBS Transplant Transplant |
$114.00
|
| Rate for Payer: Blue Shield of California Commercial |
$117.42
|
| Rate for Payer: Blue Shield of California EPN |
$92.34
|
| Rate for Payer: Caremore Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$121.60
|
| Rate for Payer: Cigna of CA PPO |
$140.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.34
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$142.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.16
|
| Rate for Payer: IEHP medi-cal |
$107.81
|
| Rate for Payer: IEHP Medicare Advantage |
$65.34
|
| Rate for Payer: Innovage PACE Commercial |
$98.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.56
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Medicare |
$69.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: Riverside University Health MISP |
$71.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.93
|
| Rate for Payer: United Healthcare All Other HMO |
$52.93
|
| Rate for Payer: United Healthcare HMO Rider |
$52.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Vantage Medical Group Senior |
$65.34
|
|
|
HC SOM MTHFR MUTATION DETECTION
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900914663
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC SOM M. TUBERCULOSIS PCR
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900912875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$41.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.68
|
| 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 |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.35
|
| Rate for Payer: Blue Shield of California EPN |
$36.45
|
| Rate for Payer: Caremore Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.68
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.36
|
| Rate for Payer: IEHP medi-cal |
$68.77
|
| Rate for Payer: IEHP Medicare Advantage |
$41.68
|
| Rate for Payer: Innovage PACE Commercial |
$62.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$44.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: Riverside University Health MISP |
$45.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOM M. TUBERCULOSIS PCR
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900912875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM MUMPS AB IGG CSF
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900911356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.05
|
| 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 |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: IEHP medi-cal |
$21.53
|
| Rate for Payer: IEHP Medicare Advantage |
$13.05
|
| Rate for Payer: Innovage PACE Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MUMPS AB IGG CSF
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900911356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM MUMPS AB IGM CSF
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.05
|
| 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 |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: IEHP medi-cal |
$21.53
|
| Rate for Payer: IEHP Medicare Advantage |
$13.05
|
| Rate for Payer: Innovage PACE Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MUMPS AB IGM CSF
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM MUR 85549
|
Facility
OP
|
$26.87
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900914739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$166.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.44
|
| Rate for Payer: BCBS Transplant Transplant |
$16.12
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Blue Shield of California EPN |
$13.06
|
| Rate for Payer: Caremore Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Central Health Plan Commercial |
$21.50
|
| Rate for Payer: Cigna of CA HMO |
$17.20
|
| Rate for Payer: Cigna of CA PPO |
$19.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$22.84
|
| Rate for Payer: Global Benefits Group Commercial |
$16.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.75
|
| Rate for Payer: IEHP medi-cal |
$30.94
|
| Rate for Payer: IEHP Medicare Advantage |
$18.75
|
| Rate for Payer: Innovage PACE Commercial |
$28.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$20.15
|
| Rate for Payer: Networks By Design Commercial |
$17.47
|
| Rate for Payer: Prime Health Services Commercial |
$22.84
|
| Rate for Payer: Prime Health Services Medicare |
$19.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.12
|
| Rate for Payer: Riverside University Health MISP |
$20.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.19
|
| Rate for Payer: United Healthcare HMO Rider |
$15.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC SOM MUR 85549
|
Facility
IP
|
$26.87
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900914739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Central Health Plan Commercial |
$21.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: Galaxy Health WC |
$22.84
|
| Rate for Payer: Global Benefits Group Commercial |
$16.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Multiplan Commercial |
$20.15
|
| Rate for Payer: Networks By Design Commercial |
$17.47
|
| Rate for Payer: Prime Health Services Commercial |
$22.84
|
|
|
HC SOM MURAMIDASE SERUM
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900911063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$166.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.44
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.75
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.75
|
| Rate for Payer: IEHP medi-cal |
$30.94
|
| Rate for Payer: IEHP Medicare Advantage |
$18.75
|
| Rate for Payer: Innovage PACE Commercial |
$28.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$19.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health MISP |
$20.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.19
|
| Rate for Payer: United Healthcare HMO Rider |
$15.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
