|
HC SOM PARASITIC EXAM CONC
|
Facility
|
OP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.26
|
| Rate for Payer: Blue Distinction Transplant |
$17.23
|
| Rate for Payer: Blue Shield of California Commercial |
$17.74
|
| Rate for Payer: Blue Shield of California EPN |
$13.95
|
| Rate for Payer: Caremore Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.97
|
| Rate for Payer: Cigna of CA HMO |
$18.37
|
| Rate for Payer: Cigna of CA PPO |
$21.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Media |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$24.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: InnovAge PACE Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$21.53
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.40
|
| Rate for Payer: Prime Health Services Medicare |
$7.08
|
| Rate for Payer: Riverside University Health System MISP |
$7.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
|
IP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.84 |
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Central Health Plan Commercial |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$21.53
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.40
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
|
OP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$155.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.98
|
| Rate for Payer: Blue Distinction Transplant |
$46.36
|
| Rate for Payer: Blue Shield of California Commercial |
$47.75
|
| Rate for Payer: Blue Shield of California EPN |
$37.55
|
| Rate for Payer: Caremore Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Central Health Plan Commercial |
$61.82
|
| Rate for Payer: Cigna of CA HMO |
$49.45
|
| Rate for Payer: Cigna of CA PPO |
$57.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Media |
$17.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$65.68
|
| Rate for Payer: Global Benefits Group Commercial |
$46.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: InnovAge PACE Commercial |
$26.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$57.95
|
| Rate for Payer: Networks By Design Commercial |
$50.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.68
|
| Rate for Payer: Prime Health Services Medicare |
$19.06
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.56
|
| Rate for Payer: United Healthcare All Other HMO |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
|
IP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$69.54 |
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Central Health Plan Commercial |
$61.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.91
|
| Rate for Payer: Galaxy Health WC |
$65.68
|
| Rate for Payer: Global Benefits Group Commercial |
$46.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$57.95
|
| Rate for Payer: Networks By Design Commercial |
$50.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.68
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.60
|
| Rate for Payer: Blue Distinction 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 |
$11.53
|
| 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 |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| 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) Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| 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 |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| 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 |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| 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: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| 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 PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$133.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.58
|
| Rate for Payer: Blue Distinction Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Caremore Medicare Advantage |
$15.03
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.54
|
| Rate for Payer: Dignity Health Media |
$15.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.03
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: InnovAge PACE Commercial |
$22.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Medicare |
$15.93
|
| Rate for Payer: Riverside University Health System MISP |
$16.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$133.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.58
|
| Rate for Payer: Blue Distinction Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Caremore Medicare Advantage |
$15.03
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.54
|
| Rate for Payer: Dignity Health Media |
$15.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.03
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: InnovAge PACE Commercial |
$22.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Medicare |
$15.93
|
| Rate for Payer: Riverside University Health System MISP |
$16.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: Blue Distinction Transplant |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$25.63
|
| Rate for Payer: Blue Shield of California EPN |
$20.16
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$33.18
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| 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 |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| 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 |
$31.11
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| 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 PARVOVIRUS B19 PCR BF
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$33.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: Blue Distinction Transplant |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$25.63
|
| Rate for Payer: Blue Shield of California EPN |
$20.16
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$33.18
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| 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 |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| 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 |
$31.11
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| 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 PARVOVIRUS PCR
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$33.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$31.11
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4.62
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM PCA3 U
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.40
|
| Rate for Payer: Blue Distinction 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: 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 |
$425.00
|
| Rate for Payer: Dignity Health Media |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$375.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.00
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$200.00
|
| 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 |
$250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOM PCA3 U
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| 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: Kaiser Permanente of CA Medi-Cal |
$190.50
|
| 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 PCDEC ANNA1
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC ANNA1
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915442
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC CASPR2-IGG
|
Facility
|
IP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
|
OP
|
$53.53
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$32.12
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.02
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.26
|
| Rate for Payer: Cigna of CA PPO |
$39.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDEC DPPX AB IFA
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$48.18 |
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$45.50
|
| Rate for Payer: Global Benefits Group Commercial |
$32.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$40.15
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.50
|
|
|
HC SOM PCDEC GABA-B-R AB CBA
|
Facility
|
OP
|
$53.52
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: Blue Distinction Transplant |
$32.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Central Health Plan Commercial |
$42.82
|
| Rate for Payer: Cigna of CA HMO |
$34.25
|
| Rate for Payer: Cigna of CA PPO |
$39.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$45.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$40.14
|
| Rate for Payer: Networks By Design Commercial |
$34.79
|
| Rate for Payer: Prime Health Services Commercial |
$45.49
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
