|
HC HIP JT LOCK EA
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.41 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Adventist Health Commercial |
$416.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$761.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.43
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$862.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$862.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$862.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$335.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$370.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$507.50
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: Riverside University Health System MISP |
$406.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$862.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$862.75
|
| Rate for Payer: Vantage Medical Group Senior |
$862.75
|
|
|
HC HIP JT LOCK EA
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
915352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$659.75
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC HIP JT LOCK EA
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT L2610
|
| Hospital Charge Code |
905352610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$913.50 |
| Rate for Payer: Adventist Health Commercial |
$203.00
|
| Rate for Payer: Blue Shield of California Commercial |
$814.03
|
| Rate for Payer: Blue Shield of California EPN |
$511.56
|
| Rate for Payer: Cash Price |
$456.75
|
| Rate for Payer: Central Health Plan Commercial |
$812.00
|
| Rate for Payer: Cigna of CA HMO |
$710.50
|
| Rate for Payer: Cigna of CA PPO |
$710.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$406.00
|
| Rate for Payer: Galaxy Health WC |
$862.75
|
| Rate for Payer: Global Benefits Group Commercial |
$609.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$913.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$644.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$598.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$761.25
|
| Rate for Payer: Networks By Design Commercial |
$659.75
|
| Rate for Payer: Prime Health Services Commercial |
$862.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$380.93
|
| Rate for Payer: United Healthcare All Other HMO |
$370.78
|
| Rate for Payer: United Healthcare HMO Rider |
$362.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.41
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,036.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$762.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.52
|
| Rate for Payer: Blue Shield of California Commercial |
$219.24
|
| Rate for Payer: Blue Shield of California Commercial |
$665.28
|
| Rate for Payer: Blue Shield of California EPN |
$138.16
|
| Rate for Payer: Blue Shield of California EPN |
$419.23
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Central Health Plan Commercial |
$278.40
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$243.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Prime Health Services Medicare |
$1,098.41
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Riverside University Health System MISP |
$1,139.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$40.32
|
| Rate for Payer: Blue Shield of California Commercial |
$117.18
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Blue Shield of California EPN |
$73.84
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$119.04
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$137.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HISTONE AUTO AB
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC HISTOTRIPSY MLGNT HPTCLLR TISSUE
|
Facility
|
OP
|
$55,078.00
|
|
|
Service Code
|
CPT 0686T
|
| Hospital Charge Code |
906811874
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$49,570.20 |
| Rate for Payer: Adventist Health Commercial |
$11,015.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,031.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,047.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,234.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,031.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Central Health Plan Commercial |
$44,062.40
|
| Rate for Payer: Cigna of CA HMO |
$35,249.92
|
| Rate for Payer: Cigna of CA PPO |
$40,757.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,047.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,234.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,031.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38,554.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,351.78
|
| Rate for Payer: EPIC Health Plan Senior |
$24,234.52
|
| Rate for Payer: Galaxy Health WC |
$46,816.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33,046.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$49,570.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,131.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,031.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,974.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,993.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,843.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,015.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,522.05
|
| Rate for Payer: Multiplan Commercial |
$41,308.50
|
| Rate for Payer: Networks By Design Commercial |
$35,800.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,031.38
|
| Rate for Payer: Prime Health Services Commercial |
$46,816.30
|
| Rate for Payer: Prime Health Services Medicare |
$23,353.26
|
| Rate for Payer: Riverside University Health System MISP |
$24,234.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33,046.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$27,539.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,539.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27,539.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27,539.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,031.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,047.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,234.52
|
| Rate for Payer: Vantage Medical Group Senior |
$22,031.38
|
|
|
HC HISTOTRIPSY MLGNT HPTCLLR TISSUE
|
Facility
|
IP
|
$55,078.00
|
|
|
Service Code
|
CPT 0686T
|
| Hospital Charge Code |
906811874
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,015.60 |
| Max. Negotiated Rate |
$49,570.20 |
| Rate for Payer: Adventist Health Commercial |
$11,015.60
|
| Rate for Payer: Cash Price |
$24,785.10
|
| Rate for Payer: Central Health Plan Commercial |
$44,062.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38,554.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,031.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,031.20
|
| Rate for Payer: Galaxy Health WC |
$46,816.30
|
| Rate for Payer: Global Benefits Group Commercial |
$33,046.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$49,570.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,974.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,496.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,015.60
|
| Rate for Payer: Multiplan Commercial |
$41,308.50
|
| Rate for Payer: Networks By Design Commercial |
$35,800.70
|
| Rate for Payer: Prime Health Services Commercial |
$46,816.30
|
|
|
HC HIT SCREEN PF4 H AB
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
900912035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$108.60 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Commercial |
$19.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.60
|
| Rate for Payer: Blue Shield of California Commercial |
$61.11
|
| Rate for Payer: Blue Shield of California Commercial |
$73.08
|
| Rate for Payer: Blue Shield of California EPN |
$38.51
|
| Rate for Payer: Blue Shield of California EPN |
$46.05
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Central Health Plan Commercial |
$77.60
|
| Rate for Payer: Cigna of CA HMO |
$62.08
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$71.78
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$82.45
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$58.20
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Networks By Design Commercial |
$63.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$82.45
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.21
|
| Rate for Payer: Prime Health Services Medicare |
$13.21
|
| Rate for Payer: Riverside University Health System MISP |
$13.71
|
| Rate for Payer: Riverside University Health System MISP |
$13.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC HIT SCREEN PF4 H AB
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
900912035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$142.92 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.92
|
| Rate for Payer: Blue Shield of California Commercial |
$160.65
|
| Rate for Payer: Blue Shield of California Commercial |
$95.13
|
| Rate for Payer: Blue Shield of California EPN |
$101.23
|
| Rate for Payer: Blue Shield of California EPN |
$59.95
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Central Health Plan Commercial |
$204.00
|
| Rate for Payer: Cigna of CA HMO |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$188.70
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.71
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Prime Health Services Medicare |
$14.53
|
| Rate for Payer: Prime Health Services Medicare |
$14.53
|
| Rate for Payer: Riverside University Health System MISP |
$15.08
|
| Rate for Payer: Riverside University Health System MISP |
$15.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Central Health Plan Commercial |
$204.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Senior |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC HIV 1/2 AG AB
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT G0475 QW
|
| Hospital Charge Code |
900912044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$181.56 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$181.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.21
|
| Rate for Payer: Blue Shield of California Commercial |
$18.27
|
| Rate for Payer: Blue Shield of California EPN |
$11.51
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.08
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$198.82 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.82
|
| Rate for Payer: Blue Shield of California Commercial |
$34.02
|
| Rate for Payer: Blue Shield of California Commercial |
$71.19
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Blue Shield of California EPN |
$44.86
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.08
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.81
|
| Rate for Payer: Blue Shield of California Commercial |
$59.85
|
| Rate for Payer: Blue Shield of California Commercial |
$68.67
|
| Rate for Payer: Blue Shield of California EPN |
$37.72
|
| Rate for Payer: Blue Shield of California EPN |
$43.27
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.00
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.67
|
| Rate for Payer: EPIC Health Plan Senior |
$9.78
|
| Rate for Payer: EPIC Health Plan Senior |
$9.78
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.89
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.89
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Prime Health Services Medicare |
$9.42
|
| Rate for Payer: Riverside University Health System MISP |
$9.78
|
| Rate for Payer: Riverside University Health System MISP |
$9.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.68
|
| Rate for Payer: Blue Shield of California Commercial |
$109.62
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$69.08
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$139.20
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.70
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.24
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.06
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$26.47
|
| Rate for Payer: Riverside University Health System MISP |
$26.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Adventist Health Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Senior |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$110.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Multiplan Commercial |
$130.50
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$138.90 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Blue Shield of California Commercial |
$88.20
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$55.58
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$198.82 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.82
|
| Rate for Payer: Blue Shield of California Commercial |
$35.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California EPN |
$22.63
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.73
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: EPIC Health Plan Senior |
$26.49
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.08
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Prime Health Services Medicare |
$25.52
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Riverside University Health System MISP |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
