|
HC SOM VPHIV 87900
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$156.87 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.72
|
| Rate for Payer: EPIC Health Plan Senior |
$69.72
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.86
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: Networks By Design Commercial |
$113.30
|
| Rate for Payer: Prime Health Services Commercial |
$148.16
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| 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 WESTERN EQUINE ENCEPH AB IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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 |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| 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: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: InnovAge PACE Commercial |
$19.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| 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 |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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 |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| 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: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: InnovAge PACE Commercial |
$19.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| 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 |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM WESTERN EQUINE ENCEPH AB IGM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900912651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| 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 WEST NILE VIRUS AB
|
Facility
|
IP
|
$18.39
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$16.55 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Central Health Plan Commercial |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.36
|
| Rate for Payer: EPIC Health Plan Senior |
$7.36
|
| Rate for Payer: Galaxy Health WC |
$15.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: Prime Health Services Commercial |
$15.63
|
|
|
HC SOM WEST NILE VIRUS AB
|
Facility
|
OP
|
$18.39
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912544
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Commercial |
$3.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.33
|
| Rate for Payer: Blue Shield of California Commercial |
$11.16
|
| Rate for Payer: Blue Shield of California EPN |
$7.30
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Cash Price |
$18.39
|
| Rate for Payer: Central Health Plan Commercial |
$14.71
|
| Rate for Payer: Cigna of CA HMO |
$11.77
|
| Rate for Payer: Cigna of CA PPO |
$13.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$15.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: InnovAge PACE Commercial |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$13.79
|
| Rate for Payer: Networks By Design Commercial |
$11.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.63
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Riverside University Health System MISP |
$18.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Adventist Health Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Central Health Plan Commercial |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.26
|
| Rate for Payer: EPIC Health Plan Senior |
$6.26
|
| Rate for Payer: Galaxy Health WC |
$13.31
|
| Rate for Payer: Global Benefits Group Commercial |
$9.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$11.74
|
| Rate for Payer: Networks By Design Commercial |
$10.18
|
| Rate for Payer: Prime Health Services Commercial |
$13.31
|
|
|
HC SOM WEST NILE VIRUS AB IGG CSF
|
Facility
|
OP
|
$15.66
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$102.41 |
| Rate for Payer: Adventist Health Commercial |
$3.13
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.78
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.22
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Central Health Plan Commercial |
$12.53
|
| Rate for Payer: Cigna of CA HMO |
$10.02
|
| Rate for Payer: Cigna of CA PPO |
$11.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$13.31
|
| Rate for Payer: Global Benefits Group Commercial |
$9.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: InnovAge PACE Commercial |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$11.74
|
| Rate for Payer: Networks By Design Commercial |
$10.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$13.31
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Central Health Plan Commercial |
$12.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.28
|
| Rate for Payer: EPIC Health Plan Senior |
$6.28
|
| Rate for Payer: Galaxy Health WC |
$13.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$11.78
|
| Rate for Payer: Networks By Design Commercial |
$10.21
|
| Rate for Payer: Prime Health Services Commercial |
$13.35
|
|
|
HC SOM WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$102.41 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.78
|
| Rate for Payer: Blue Shield of California Commercial |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.24
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Central Health Plan Commercial |
$12.57
|
| Rate for Payer: Cigna of CA HMO |
$10.05
|
| Rate for Payer: Cigna of CA PPO |
$11.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$13.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: InnovAge PACE Commercial |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$11.78
|
| Rate for Payer: Networks By Design Commercial |
$10.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$13.35
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.34
|
| Rate for Payer: EPIC Health Plan Senior |
$7.34
|
| Rate for Payer: Galaxy Health WC |
$15.59
|
| Rate for Payer: Global Benefits Group Commercial |
$11.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$11.92
|
| Rate for Payer: Prime Health Services Commercial |
$15.59
|
|
|
HC SOM WEST NILE VIRUS AB IGM CSF
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
900912164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Commercial |
$3.67
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.33
|
| Rate for Payer: Blue Shield of California Commercial |
$11.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.28
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.67
|
| Rate for Payer: Cigna of CA HMO |
$11.74
|
| Rate for Payer: Cigna of CA PPO |
$13.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$15.59
|
| Rate for Payer: Global Benefits Group Commercial |
$11.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: InnovAge PACE Commercial |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$11.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Riverside University Health System MISP |
$18.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$50.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| 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 |
$16.80
|
| 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 |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| 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 |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM WEST NILE VIRUS PCR
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912543
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
|
|
HC SOM WEST NILE VIRUS PCR (CSF)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912764
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$50.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.35
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| 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 |
$16.80
|
| 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 |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| 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 |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM WHEY IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| 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 WHEY IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.54
|
| 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 |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| 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 Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| 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: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| 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: Upland Medical Group Pediatric |
$5.22
|
| 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 Y ENTEROCOL AB A G M
|
Facility
|
OP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$202.19 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$136.36
|
| Rate for Payer: Blue Shield of California EPN |
$89.19
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Central Health Plan Commercial |
$179.72
|
| Rate for Payer: Cigna of CA HMO |
$143.78
|
| Rate for Payer: Cigna of CA PPO |
$166.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: InnovAge PACE Commercial |
$19.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$168.49
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
IP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.93 |
| Max. Negotiated Rate |
$202.19 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Central Health Plan Commercial |
$179.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.86
|
| Rate for Payer: EPIC Health Plan Senior |
$89.86
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.93
|
| Rate for Payer: Multiplan Commercial |
$168.49
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
|
|
HC SOM ZINC
|
Facility
|
OP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$82.87 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7.39
|
| Rate for Payer: Blue Shield of California EPN |
$4.83
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.74
|
| Rate for Payer: Cigna of CA HMO |
$7.79
|
| Rate for Payer: Cigna of CA PPO |
$9.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$11.39
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: InnovAge PACE Commercial |
$17.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
| Rate for Payer: Networks By Design Commercial |
$7.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Medicare |
$12.07
|
| Rate for Payer: Riverside University Health System MISP |
$12.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZINC
|
Facility
|
IP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.95 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Central Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$9.13
|
| Rate for Payer: Networks By Design Commercial |
$7.91
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.70
|
| Rate for Payer: Blue Shield of California Commercial |
$91.05
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: InnovAge PACE Commercial |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
