|
HC HLA-DP MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903902018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.98 |
| Max. Negotiated Rate |
$552.82 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Adventist Health Commercial |
$178.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$106.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$106.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.82
|
| Rate for Payer: Blue Shield of California Commercial |
$563.22
|
| Rate for Payer: Blue Shield of California Commercial |
$368.55
|
| Rate for Payer: Blue Shield of California EPN |
$354.92
|
| Rate for Payer: Blue Shield of California EPN |
$232.25
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$409.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.13
|
| Rate for Payer: EPIC Health Plan Senior |
$116.75
|
| Rate for Payer: EPIC Health Plan Senior |
$116.75
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$174.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$371.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.23
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$106.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$106.14
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Medicare |
$112.51
|
| Rate for Payer: Prime Health Services Medicare |
$112.51
|
| Rate for Payer: Riverside University Health System MISP |
$116.75
|
| Rate for Payer: Riverside University Health System MISP |
$116.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| Rate for Payer: United Healthcare All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,107.90 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Central Health Plan Commercial |
$984.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.20
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC HLA DQ MOLECULAR
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901992
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,107.90 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$550.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$550.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$764.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$764.85
|
| Rate for Payer: Blue Shield of California Commercial |
$321.30
|
| Rate for Payer: Blue Shield of California Commercial |
$775.53
|
| Rate for Payer: Blue Shield of California EPN |
$202.47
|
| Rate for Payer: Blue Shield of California EPN |
$488.71
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Central Health Plan Commercial |
$984.80
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| Rate for Payer: Cigna of CA HMO |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$377.40
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$433.50
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$459.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.22
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Prime Health Services Medicare |
$129.55
|
| Rate for Payer: Prime Health Services Medicare |
$129.55
|
| Rate for Payer: Riverside University Health System MISP |
$134.44
|
| Rate for Payer: Riverside University Health System MISP |
$134.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.81
|
| Rate for Payer: Blue Shield of California Commercial |
$136.71
|
| Rate for Payer: Blue Shield of California Commercial |
$965.79
|
| Rate for Payer: Blue Shield of California EPN |
$86.15
|
| Rate for Payer: Blue Shield of California EPN |
$608.60
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,226.40
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA HMO |
$981.12
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Cigna of CA PPO |
$1,134.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,379.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Multiplan Commercial |
$1,149.75
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$919.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA DQ MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,226.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$613.20
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,379.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$904.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.60
|
| Rate for Payer: Multiplan Commercial |
$1,149.75
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$1,338.45 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$220.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$658.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$331.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$962.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,338.45
|
| Rate for Payer: Blue Shield of California Commercial |
$680.40
|
| Rate for Payer: Blue Shield of California EPN |
$428.76
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: Cigna of CA HMO |
$691.20
|
| Rate for Payer: Cigna of CA PPO |
$799.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$331.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.22
|
| Rate for Payer: EPIC Health Plan Senior |
$242.81
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$362.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$337.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$220.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$295.79
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$220.74
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
| Rate for Payer: Prime Health Services Medicare |
$233.98
|
| Rate for Payer: Riverside University Health System MISP |
$242.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$648.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other HMO |
$178.80
|
| Rate for Payer: United Healthcare HMO Rider |
$178.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$220.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$331.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.81
|
| Rate for Payer: Vantage Medical Group Senior |
$220.74
|
|
|
HC HLA-DR/DQ MOLECULAR
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 81375
|
| Hospital Charge Code |
903901901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Senior |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.40
|
| Rate for Payer: EPIC Health Plan Senior |
$296.40
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
|
|
HC HLA-DR/DQ SEROLOGY
|
Facility
|
OP
|
$741.00
|
|
|
Service Code
|
CPT 86817
|
| Hospital Charge Code |
903901986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.98 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Adventist Health Commercial |
$148.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$106.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.82
|
| Rate for Payer: Blue Shield of California Commercial |
$466.83
|
| Rate for Payer: Blue Shield of California EPN |
$294.18
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Central Health Plan Commercial |
$592.80
|
| Rate for Payer: Cigna of CA HMO |
$474.24
|
| Rate for Payer: Cigna of CA PPO |
$548.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.13
|
| Rate for Payer: EPIC Health Plan Senior |
$116.75
|
| Rate for Payer: Galaxy Health WC |
$629.85
|
| Rate for Payer: Global Benefits Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$174.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.23
|
| Rate for Payer: Multiplan Commercial |
$555.75
|
| Rate for Payer: Networks By Design Commercial |
$481.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$106.14
|
| Rate for Payer: Prime Health Services Commercial |
$629.85
|
| Rate for Payer: Prime Health Services Medicare |
$112.51
|
| Rate for Payer: Riverside University Health System MISP |
$116.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.98
|
| Rate for Payer: United Healthcare All Other HMO |
$85.98
|
| Rate for Payer: United Healthcare HMO Rider |
$85.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$106.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.75
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,107.90 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Central Health Plan Commercial |
$984.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$726.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.20
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC HLA DR MOLECULAR
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
903901991
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,107.90 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$122.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$550.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$550.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$764.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$764.85
|
| Rate for Payer: Blue Shield of California Commercial |
$321.30
|
| Rate for Payer: Blue Shield of California Commercial |
$775.53
|
| Rate for Payer: Blue Shield of California EPN |
$202.47
|
| Rate for Payer: Blue Shield of California EPN |
$488.71
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Central Health Plan Commercial |
$984.80
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| Rate for Payer: Cigna of CA HMO |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$377.40
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$134.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$861.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.66
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: EPIC Health Plan Senior |
$134.44
|
| Rate for Payer: Galaxy Health WC |
$433.50
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$459.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$200.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$186.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$781.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$163.77
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$923.25
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$122.22
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Prime Health Services Medicare |
$129.55
|
| Rate for Payer: Prime Health Services Medicare |
$129.55
|
| Rate for Payer: Riverside University Health System MISP |
$134.44
|
| Rate for Payer: Riverside University Health System MISP |
$134.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$122.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.44
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
| Rate for Payer: Vantage Medical Group Senior |
$122.22
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.60 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,226.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.20
|
| Rate for Payer: EPIC Health Plan Senior |
$613.20
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,379.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$904.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.60
|
| Rate for Payer: Multiplan Commercial |
$1,149.75
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
|
|
HC HLA DR MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
903901993
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Adventist Health Commercial |
$306.60
|
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$851.81
|
| Rate for Payer: Blue Shield of California Commercial |
$136.71
|
| Rate for Payer: Blue Shield of California Commercial |
$965.79
|
| Rate for Payer: Blue Shield of California EPN |
$86.15
|
| Rate for Payer: Blue Shield of California EPN |
$608.60
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Cash Price |
$689.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,226.40
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA HMO |
$981.12
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Cigna of CA PPO |
$1,134.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Galaxy Health WC |
$1,303.05
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$919.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,379.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$973.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Multiplan Commercial |
$1,149.75
|
| Rate for Payer: Networks By Design Commercial |
$996.45
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.05
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$919.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$177.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$177.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.95
|
| Rate for Payer: Blue Shield of California Commercial |
$119.07
|
| Rate for Payer: Blue Shield of California Commercial |
$840.42
|
| Rate for Payer: Blue Shield of California EPN |
$75.03
|
| Rate for Payer: Blue Shield of California EPN |
$529.60
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: EPIC Health Plan Senior |
$194.97
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$248.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$177.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$177.25
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Prime Health Services Medicare |
$187.88
|
| Rate for Payer: Prime Health Services Medicare |
$187.88
|
| Rate for Payer: Riverside University Health System MISP |
$194.97
|
| Rate for Payer: Riverside University Health System MISP |
$194.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$177.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$787.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$1,221.94 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Adventist Health Commercial |
$88.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$127.43
|
| Rate for Payer: Adventist Health Medi-Cal |
$127.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$878.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$878.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,221.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,221.94
|
| Rate for Payer: Blue Shield of California Commercial |
$279.72
|
| Rate for Payer: Blue Shield of California Commercial |
$840.42
|
| Rate for Payer: Blue Shield of California EPN |
$176.27
|
| Rate for Payer: Blue Shield of California EPN |
$529.60
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: Central Health Plan Commercial |
$355.20
|
| Rate for Payer: Cigna of CA HMO |
$284.16
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$328.56
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.26
|
| Rate for Payer: EPIC Health Plan Senior |
$140.17
|
| Rate for Payer: EPIC Health Plan Senior |
$140.17
|
| Rate for Payer: Galaxy Health WC |
$377.40
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$266.40
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$208.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$333.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Networks By Design Commercial |
$288.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$127.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$127.43
|
| Rate for Payer: Prime Health Services Commercial |
$377.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Prime Health Services Medicare |
$135.08
|
| Rate for Payer: Prime Health Services Medicare |
$135.08
|
| Rate for Payer: Riverside University Health System MISP |
$140.17
|
| Rate for Payer: Riverside University Health System MISP |
$140.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$127.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$127.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903913211
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$787.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$817.49 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.49
|
| Rate for Payer: Blue Shield of California Commercial |
$582.75
|
| Rate for Payer: Blue Shield of California Commercial |
$510.30
|
| Rate for Payer: Blue Shield of California EPN |
$367.23
|
| Rate for Payer: Blue Shield of California EPN |
$321.57
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$743.13 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.13
|
| Rate for Payer: Blue Shield of California Commercial |
$582.75
|
| Rate for Payer: Blue Shield of California Commercial |
$495.18
|
| Rate for Payer: Blue Shield of California EPN |
$367.23
|
| Rate for Payer: Blue Shield of California EPN |
$312.04
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$743.13 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.13
|
| Rate for Payer: Blue Shield of California Commercial |
$582.75
|
| Rate for Payer: Blue Shield of California Commercial |
$495.18
|
| Rate for Payer: Blue Shield of California EPN |
$367.23
|
| Rate for Payer: Blue Shield of California EPN |
$312.04
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$817.49 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$732.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$817.49
|
| Rate for Payer: Blue Shield of California Commercial |
$582.75
|
| Rate for Payer: Blue Shield of California Commercial |
$510.30
|
| Rate for Payer: Blue Shield of California EPN |
$367.23
|
| Rate for Payer: Blue Shield of California EPN |
$321.57
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.19
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: EPIC Health Plan Senior |
$356.12
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$530.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$323.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare All Other HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$323.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$485.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
