|
HC SOM VOLATILES URINE
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM VOLATILES URINE
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.00
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: IEHP medi-cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health MISP |
$18.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
IP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
OP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$203.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: BCBS Transplant Transplant |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15.66
|
| Rate for Payer: Blue Shield of California EPN |
$12.32
|
| Rate for Payer: Caremore Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: IEHP medi-cal |
$37.85
|
| Rate for Payer: IEHP Medicare Advantage |
$22.94
|
| Rate for Payer: Innovage PACE Commercial |
$34.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Medicare |
$24.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: Riverside University Health MISP |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.58
|
| Rate for Payer: United Healthcare All Other HMO |
$18.58
|
| Rate for Payer: United Healthcare HMO Rider |
$18.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
IP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Central Health Plan Commercial |
$59.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.68
|
| Rate for Payer: Galaxy Health WC |
$63.07
|
| Rate for Payer: Global Benefits Group Commercial |
$44.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
| Rate for Payer: Networks By Design Commercial |
$48.23
|
| Rate for Payer: Prime Health Services Commercial |
$63.07
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
OP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$30.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.00
|
| Rate for Payer: BCBS Transplant Transplant |
$44.52
|
| Rate for Payer: Blue Shield of California Commercial |
$45.86
|
| Rate for Payer: Blue Shield of California EPN |
$36.06
|
| Rate for Payer: Caremore Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Cash Price |
$33.39
|
| Rate for Payer: Central Health Plan Commercial |
$59.36
|
| Rate for Payer: Cigna of CA HMO |
$47.49
|
| Rate for Payer: Cigna of CA PPO |
$54.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.86
|
| Rate for Payer: Galaxy Health WC |
$63.07
|
| Rate for Payer: Global Benefits Group Commercial |
$44.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$55.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.61
|
| Rate for Payer: IEHP medi-cal |
$50.92
|
| Rate for Payer: IEHP Medicare Advantage |
$30.86
|
| Rate for Payer: Innovage PACE Commercial |
$46.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.35
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
| Rate for Payer: Networks By Design Commercial |
$48.23
|
| Rate for Payer: Prime Health Services Commercial |
$63.07
|
| Rate for Payer: Prime Health Services Medicare |
$32.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$44.52
|
| Rate for Payer: Riverside University Health MISP |
$33.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.44
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$38.32
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$203.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: BCBS Transplant Transplant |
$30.66
|
| Rate for Payer: Blue Shield of California Commercial |
$31.58
|
| Rate for Payer: Blue Shield of California EPN |
$24.83
|
| Rate for Payer: Caremore Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.88
|
| Rate for Payer: Cigna of CA HMO |
$32.70
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: IEHP medi-cal |
$37.85
|
| Rate for Payer: IEHP Medicare Advantage |
$22.94
|
| Rate for Payer: Innovage PACE Commercial |
$34.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$38.32
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
| Rate for Payer: Prime Health Services Medicare |
$24.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.66
|
| Rate for Payer: Riverside University Health MISP |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.58
|
| Rate for Payer: United Healthcare All Other HMO |
$18.58
|
| Rate for Payer: United Healthcare HMO Rider |
$18.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$141.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.25
|
| Rate for Payer: BCBS Transplant Transplant |
$16.27
|
| Rate for Payer: Blue Shield of California Commercial |
$16.75
|
| Rate for Payer: Blue Shield of California EPN |
$13.18
|
| Rate for Payer: Caremore Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: IEHP medi-cal |
$44.73
|
| Rate for Payer: IEHP Medicare Advantage |
$27.11
|
| Rate for Payer: Innovage PACE Commercial |
$40.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: Riverside University Health MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM VPHIV 87900
|
Facility
OP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$1,131.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$130.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$956.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$195.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$130.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$927.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,131.42
|
| Rate for Payer: BCBS Transplant Transplant |
$104.58
|
| Rate for Payer: Blue Shield of California Commercial |
$107.72
|
| Rate for Payer: Blue Shield of California EPN |
$84.71
|
| Rate for Payer: Caremore Medicare Advantage |
$130.35
|
| Rate for Payer: Cash Price |
$78.44
|
| Rate for Payer: Cash Price |
$78.44
|
| Rate for Payer: Central Health Plan Commercial |
$139.44
|
| Rate for Payer: Cigna of CA HMO |
$111.55
|
| Rate for Payer: Cigna of CA PPO |
$128.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$130.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.35
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$130.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$213.77
|
| Rate for Payer: IEHP medi-cal |
$215.08
|
| Rate for Payer: IEHP Medicare Advantage |
$130.35
|
| Rate for Payer: Innovage PACE Commercial |
$195.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.67
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$138.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.58
|
| Rate for Payer: Riverside University Health MISP |
$143.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.59
|
| Rate for Payer: United Healthcare All Other HMO |
$105.59
|
| Rate for Payer: United Healthcare HMO Rider |
$105.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.38
|
| Rate for Payer: Vantage Medical Group Senior |
$130.35
|
|
|
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: Cash Price |
$78.44
|
| Rate for Payer: Central Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
OP
|
$25.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
900911337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: IEHP medi-cal |
$21.76
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Innovage PACE Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| 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: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM 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: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM 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 |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: IEHP medi-cal |
$21.76
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Innovage PACE Commercial |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| 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: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM 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: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM 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 |
$146.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: AlphaCare 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 |
$146.24
|
| Rate for Payer: BCBS Transplant Transplant |
$11.03
|
| Rate for Payer: Blue Shield of California Commercial |
$11.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.94
|
| Rate for Payer: Caremore Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: Cash Price |
$8.28
|
| 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 |
$25.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: IEHP medi-cal |
$27.80
|
| Rate for Payer: IEHP Medicare Advantage |
$16.85
|
| Rate for Payer: Innovage PACE Commercial |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.27
|
| 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: Prime Health Services Commercial |
$15.63
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.03
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$25.28
|
| 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
|
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: Cash Price |
$8.28
|
| Rate for Payer: Central Health Plan Commercial |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$7.05
|
| Rate for Payer: Central Health Plan Commercial |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$124.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: AlphaCare 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 |
$124.92
|
| Rate for Payer: BCBS Transplant Transplant |
$9.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Blue Shield of California EPN |
$7.61
|
| Rate for Payer: Caremore Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cash Price |
$7.05
|
| 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 |
$21.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: IEHP medi-cal |
$23.74
|
| Rate for Payer: IEHP Medicare Advantage |
$14.39
|
| Rate for Payer: Innovage PACE Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.45
|
| 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: Prime Health Services Commercial |
$13.31
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.40
|
| Rate for Payer: Riverside University Health 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 |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| 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
OP
|
$15.71
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
900912602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$124.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: AlphaCare 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 |
$124.92
|
| Rate for Payer: BCBS Transplant Transplant |
$9.43
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.64
|
| Rate for Payer: Caremore Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cash Price |
$7.07
|
| 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 |
$21.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$11.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: IEHP medi-cal |
$23.74
|
| Rate for Payer: IEHP Medicare Advantage |
$14.39
|
| Rate for Payer: Innovage PACE Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.48
|
| 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: Prime Health Services Commercial |
$13.35
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.43
|
| Rate for Payer: Riverside University Health 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 |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| 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: Cash Price |
$7.07
|
| Rate for Payer: Central Health Plan Commercial |
$12.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$146.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: AlphaCare 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 |
$146.24
|
| Rate for Payer: BCBS Transplant Transplant |
$11.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California EPN |
$8.91
|
| Rate for Payer: Caremore Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| 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 |
$25.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.63
|
| Rate for Payer: IEHP medi-cal |
$27.80
|
| Rate for Payer: IEHP Medicare Advantage |
$16.85
|
| Rate for Payer: Innovage PACE Commercial |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.23
|
| 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: Prime Health Services Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Medicare |
$17.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$25.28
|
| 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 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: Cash Price |
$8.25
|
| Rate for Payer: Central Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
