|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$200.21 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Central Health Plan Commercial |
$177.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.98
|
| Rate for Payer: EPIC Health Plan Senior |
$88.98
|
| Rate for Payer: Galaxy Health WC |
$189.08
|
| Rate for Payer: Global Benefits Group Commercial |
$133.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.49
|
| Rate for Payer: Multiplan Commercial |
$166.84
|
| Rate for Payer: Networks By Design Commercial |
$144.59
|
| Rate for Payer: Prime Health Services Commercial |
$189.08
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$117.66 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.66
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$14.20
|
| Rate for Payer: Cigna of CA HMO |
$11.36
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$15.97 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$14.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.10
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.55
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$15.97 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$14.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.10
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.55
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$117.66 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.66
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$14.20
|
| Rate for Payer: Cigna of CA HMO |
$11.36
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$117.66 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.66
|
| Rate for Payer: Blue Shield of California Commercial |
$11.18
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$14.20
|
| Rate for Payer: Cigna of CA HMO |
$11.36
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$15.97 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$14.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.10
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.55
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$117.66 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$117.66 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$117.66 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Central Health Plan Commercial |
$124.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.00
|
| Rate for Payer: EPIC Health Plan Senior |
$62.00
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: Networks By Design Commercial |
$100.75
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$97.65
|
| Rate for Payer: Blue Shield of California EPN |
$61.53
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Central Health Plan Commercial |
$124.00
|
| Rate for Payer: Cigna of CA HMO |
$99.20
|
| Rate for Payer: Cigna of CA PPO |
$114.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$131.75
|
| Rate for Payer: Global Benefits Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: Networks By Design Commercial |
$100.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$131.75
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$1,682.03 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$173.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,220.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,209.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,682.03
|
| Rate for Payer: Blue Shield of California Commercial |
$59.06
|
| Rate for Payer: Blue Shield of California EPN |
$37.22
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Central Health Plan Commercial |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$60.00
|
| Rate for Payer: Cigna of CA PPO |
$69.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.54
|
| Rate for Payer: EPIC Health Plan Senior |
$191.03
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$173.66
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
| Rate for Payer: Prime Health Services Medicare |
$184.08
|
| Rate for Payer: Riverside University Health System MISP |
$191.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Central Health Plan Commercial |
$75.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.50
|
| Rate for Payer: EPIC Health Plan Senior |
$37.50
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$121.40 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$20.16
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$246.49 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.49
|
| Rate for Payer: Blue Shield of California Commercial |
$54.18
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.21
|
| Rate for Payer: EPIC Health Plan Senior |
$26.81
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.37
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$25.83
|
| Rate for Payer: Riverside University Health System MISP |
$26.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.74
|
| Rate for Payer: United Healthcare All Other HMO |
$19.74
|
| Rate for Payer: United Healthcare HMO Rider |
$19.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
OP
|
$49.63
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$121.40 |
| Rate for Payer: Adventist Health Commercial |
$9.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.27
|
| Rate for Payer: Blue Shield of California EPN |
$19.70
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Central Health Plan Commercial |
$39.70
|
| Rate for Payer: Cigna of CA HMO |
$31.76
|
| Rate for Payer: Cigna of CA PPO |
$36.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$42.19
|
| Rate for Payer: Global Benefits Group Commercial |
$29.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$37.22
|
| Rate for Payer: Networks By Design Commercial |
$32.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.19
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
IP
|
$49.63
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$44.67 |
| Rate for Payer: Adventist Health Commercial |
$9.93
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Central Health Plan Commercial |
$39.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.85
|
| Rate for Payer: EPIC Health Plan Senior |
$19.85
|
| Rate for Payer: Galaxy Health WC |
$42.19
|
| Rate for Payer: Global Benefits Group Commercial |
$29.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$37.22
|
| Rate for Payer: Networks By Design Commercial |
$32.26
|
| Rate for Payer: Prime Health Services Commercial |
$42.19
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
IP
|
$45.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Central Health Plan Commercial |
$36.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.33
|
| Rate for Payer: EPIC Health Plan Senior |
$18.33
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$34.37
|
| Rate for Payer: Networks By Design Commercial |
$29.79
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
OP
|
$45.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$121.40 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.87
|
| Rate for Payer: Blue Shield of California EPN |
$18.19
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Central Health Plan Commercial |
$36.66
|
| Rate for Payer: Cigna of CA HMO |
$29.33
|
| Rate for Payer: Cigna of CA PPO |
$33.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$34.37
|
| Rate for Payer: Networks By Design Commercial |
$29.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
