|
HC HLA DRUG SENSITIVITY
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC HLA DRUG SENSITIVITY
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
900913210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$780.40 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$177.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| 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 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 HMO/PPO |
$158.38
|
| Rate for Payer: Blue Shield of California Commercial |
$114.72
|
| Rate for Payer: Blue Shield of California EPN |
$75.03
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$177.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Senior |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| 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) Medicare Advantage |
$177.25
|
| Rate for Payer: InnovAge PACE Commercial |
$265.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.51
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| 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 Medicare |
$187.88
|
| Rate for Payer: Riverside University Health System MISP |
$194.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| 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 HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| 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 Medi-Cal |
$194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
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 |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$491.91
|
| 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 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 HMO/PPO |
$119.34
|
| Rate for Payer: Blue Shield of California Commercial |
$491.67
|
| Rate for Payer: Blue Shield of California EPN |
$321.57
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Senior |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| 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) Medicare Advantage |
$323.75
|
| Rate for Payer: InnovAge PACE Commercial |
$485.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| 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 HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| 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 Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
900913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$314.40
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$486.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
|
|
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 |
$707.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.34
|
| 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 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 HMO/PPO |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$477.10
|
| Rate for Payer: Blue Shield of California EPN |
$312.04
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Senior |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| 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) Medicare Advantage |
$325.80
|
| Rate for Payer: InnovAge PACE Commercial |
$488.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| 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 HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| 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 Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
900913203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
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 |
$707.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.34
|
| 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 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 HMO/PPO |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$477.10
|
| Rate for Payer: Blue Shield of California EPN |
$312.04
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.83
|
| Rate for Payer: EPIC Health Plan Senior |
$325.80
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| 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) Medicare Advantage |
$325.80
|
| Rate for Payer: InnovAge PACE Commercial |
$488.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| 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 HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| 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 Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC HLA DSA (PRA CLASS I&II)
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903913204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$707.40 |
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$314.40
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$486.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
|
|
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 |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$323.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$491.91
|
| 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 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 HMO/PPO |
$119.34
|
| Rate for Payer: Blue Shield of California Commercial |
$491.67
|
| Rate for Payer: Blue Shield of California EPN |
$321.57
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$356.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$323.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.06
|
| Rate for Payer: EPIC Health Plan Senior |
$323.75
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| 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) Medicare Advantage |
$323.75
|
| Rate for Payer: InnovAge PACE Commercial |
$485.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$433.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$433.82
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$323.75
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$343.18
|
| Rate for Payer: Riverside University Health System MISP |
$356.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| 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 HMO |
$262.24
|
| Rate for Payer: United Healthcare HMO Rider |
$262.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.24
|
| 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 Medi-Cal |
$356.12
|
| Rate for Payer: Vantage Medical Group Senior |
$323.75
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC HLA SERUM PROCESSING
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86849
|
| Hospital Charge Code |
903901964
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.97
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: InnovAge PACE Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$516.07 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$318.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.74
|
| Rate for Payer: Blue Shield of California Commercial |
$318.07
|
| Rate for Payer: Blue Shield of California EPN |
$208.03
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Central Health Plan Commercial |
$419.20
|
| Rate for Payer: Cigna of CA HMO |
$335.36
|
| Rate for Payer: Cigna of CA PPO |
$387.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.81
|
| Rate for Payer: EPIC Health Plan Senior |
$109.49
|
| Rate for Payer: Galaxy Health WC |
$445.40
|
| Rate for Payer: Global Benefits Group Commercial |
$314.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: InnovAge PACE Commercial |
$164.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$349.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$393.00
|
| Rate for Payer: Networks By Design Commercial |
$340.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.49
|
| Rate for Payer: Prime Health Services Commercial |
$445.40
|
| Rate for Payer: Prime Health Services Medicare |
$116.06
|
| Rate for Payer: Riverside University Health System MISP |
$120.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$314.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$314.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH AUTO
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901926
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$471.60 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Central Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$209.60
|
| Rate for Payer: Galaxy Health WC |
$445.40
|
| Rate for Payer: Global Benefits Group Commercial |
$314.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$349.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.80
|
| Rate for Payer: Multiplan Commercial |
$393.00
|
| Rate for Payer: Networks By Design Commercial |
$340.60
|
| Rate for Payer: Prime Health Services Commercial |
$445.40
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Central Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$142.00
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
|
|
HC HLA X MATCH B FLOW
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.53
|
| Rate for Payer: Blue Shield of California Commercial |
$215.49
|
| Rate for Payer: Blue Shield of California EPN |
$140.94
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Central Health Plan Commercial |
$284.00
|
| Rate for Payer: Cigna of CA HMO |
$227.20
|
| Rate for Payer: Cigna of CA PPO |
$262.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: InnovAge PACE Commercial |
$40.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Riverside University Health System MISP |
$29.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$310.80 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.14
|
| Rate for Payer: Blue Shield of California Commercial |
$159.64
|
| Rate for Payer: Blue Shield of California EPN |
$104.41
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$168.32
|
| Rate for Payer: Cigna of CA PPO |
$194.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Senior |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: InnovAge PACE Commercial |
$284.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$189.51
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
|
|
HC HLA X MATCH T FLOW
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$389.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
|
|
HC HLA X MATCH T FLOW
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$109.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$382.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$516.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.74
|
| Rate for Payer: Blue Shield of California Commercial |
$382.41
|
| Rate for Payer: Blue Shield of California EPN |
$250.11
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Central Health Plan Commercial |
$504.00
|
| Rate for Payer: Cigna of CA HMO |
$403.20
|
| Rate for Payer: Cigna of CA PPO |
$466.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.81
|
| Rate for Payer: EPIC Health Plan Senior |
$109.49
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: InnovAge PACE Commercial |
$164.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$109.49
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Prime Health Services Medicare |
$116.06
|
| Rate for Payer: Riverside University Health System MISP |
$120.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$109.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$310.80 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$189.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.14
|
| Rate for Payer: Blue Shield of California Commercial |
$159.64
|
| Rate for Payer: Blue Shield of California EPN |
$104.41
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$168.32
|
| Rate for Payer: Cigna of CA PPO |
$194.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Senior |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: InnovAge PACE Commercial |
$284.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$189.51
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Prime Health Services Medicare |
$200.88
|
| Rate for Payer: Riverside University Health System MISP |
$208.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$189.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$170.95
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$36.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$172.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.92
|
| Rate for Payer: Blue Shield of California Commercial |
$196.06
|
| Rate for Payer: Blue Shield of California EPN |
$128.23
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.32
|
| Rate for Payer: EPIC Health Plan Senior |
$36.53
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$59.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.53
|
| Rate for Payer: InnovAge PACE Commercial |
$54.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.95
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$36.53
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Prime Health Services Medicare |
$38.72
|
| Rate for Payer: Riverside University Health System MISP |
$40.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.59
|
| Rate for Payer: United Healthcare All Other HMO |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$36.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.53
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Cash Price |
$177.65
|
| Rate for Payer: Central Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$129.20
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$290.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.60
|
| Rate for Payer: Multiplan Commercial |
$242.25
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Central Health Plan Commercial |
$473.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: EPIC Health Plan Senior |
$236.80
|
| Rate for Payer: Galaxy Health WC |
$503.20
|
| Rate for Payer: Global Benefits Group Commercial |
$355.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$532.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$366.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.40
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: Networks By Design Commercial |
$384.80
|
| Rate for Payer: Prime Health Services Commercial |
$503.20
|
|
