|
HC SOM HIV-1 RNA QUANT WITH REFLEX
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900915501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$624.55 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$85.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$624.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.41
|
| Rate for Payer: EPIC Health Plan Senior |
$93.61
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$139.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$85.10
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$90.21
|
| Rate for Payer: Riverside University Health System MISP |
$93.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.93
|
| Rate for Payer: United Healthcare All Other HMO |
$68.93
|
| Rate for Payer: United Healthcare HMO Rider |
$68.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$85.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIV2 86702
|
Facility
|
IP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Senior |
$7.75
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$12.59
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
|
|
HC SOM HIV2 86702
|
Facility
|
OP
|
$19.37
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900914737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$138.90 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California EPN |
$7.69
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Central Health Plan Commercial |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$12.40
|
| Rate for Payer: Cigna of CA PPO |
$14.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$16.46
|
| Rate for Payer: Global Benefits Group Commercial |
$11.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$14.53
|
| Rate for Payer: Networks By Design Commercial |
$12.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: Prime Health Services Commercial |
$16.46
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
OP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$138.90 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.50
|
| Rate for Payer: Blue Shield of California EPN |
$17.96
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Central Health Plan Commercial |
$36.19
|
| Rate for Payer: Cigna of CA HMO |
$28.95
|
| Rate for Payer: Cigna of CA PPO |
$33.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$38.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
| Rate for Payer: Networks By Design Commercial |
$29.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: Prime Health Services Commercial |
$38.45
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV-2 ANTIBODY
|
Facility
|
IP
|
$45.24
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900915309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$40.72 |
| Rate for Payer: Adventist Health Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Central Health Plan Commercial |
$36.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.10
|
| Rate for Payer: Galaxy Health WC |
$38.45
|
| Rate for Payer: Global Benefits Group Commercial |
$27.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$33.93
|
| Rate for Payer: Networks By Design Commercial |
$29.41
|
| Rate for Payer: Prime Health Services Commercial |
$38.45
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Central Health Plan Commercial |
$46.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.12
|
| Rate for Payer: EPIC Health Plan Senior |
$23.12
|
| Rate for Payer: Galaxy Health WC |
$49.13
|
| Rate for Payer: Global Benefits Group Commercial |
$34.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$43.35
|
| Rate for Payer: Networks By Design Commercial |
$37.57
|
| Rate for Payer: Prime Health Services Commercial |
$49.13
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$138.90 |
| Rate for Payer: Adventist Health Commercial |
$11.56
|
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.90
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California Commercial |
$36.41
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Blue Shield of California EPN |
$22.95
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Central Health Plan Commercial |
$46.24
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$36.99
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Cigna of CA PPO |
$42.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.31
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: EPIC Health Plan Senior |
$14.87
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Galaxy Health WC |
$49.13
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Global Benefits Group Commercial |
$34.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$43.35
|
| Rate for Payer: Networks By Design Commercial |
$37.57
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.52
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$49.13
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Prime Health Services Medicare |
$14.33
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Riverside University Health System MISP |
$14.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM HIV DNA (PCR)
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
900911055
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$624.55 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$85.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$624.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.41
|
| Rate for Payer: EPIC Health Plan Senior |
$93.61
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$139.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.03
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$85.10
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$90.21
|
| Rate for Payer: Riverside University Health System MISP |
$93.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.93
|
| Rate for Payer: United Healthcare All Other HMO |
$68.93
|
| Rate for Payer: United Healthcare HMO Rider |
$68.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$85.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.61
|
| Rate for Payer: Vantage Medical Group Senior |
$85.10
|
|
|
HC SOM HIVE 86703
|
Facility
|
IP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Central Health Plan Commercial |
$91.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.78
|
| Rate for Payer: EPIC Health Plan Senior |
$45.78
|
| Rate for Payer: Galaxy Health WC |
$97.28
|
| Rate for Payer: Global Benefits Group Commercial |
$68.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
| Rate for Payer: Networks By Design Commercial |
$74.39
|
| Rate for Payer: Prime Health Services Commercial |
$97.28
|
|
|
HC SOM HIVE 86703
|
Facility
|
OP
|
$114.45
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900914736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$142.92 |
| Rate for Payer: Adventist Health Commercial |
$22.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.92
|
| Rate for Payer: Blue Shield of California Commercial |
$72.10
|
| Rate for Payer: Blue Shield of California EPN |
$45.44
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Cash Price |
$114.45
|
| Rate for Payer: Central Health Plan Commercial |
$91.56
|
| Rate for Payer: Cigna of CA HMO |
$73.25
|
| Rate for Payer: Cigna of CA PPO |
$84.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.62
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$97.28
|
| Rate for Payer: Global Benefits Group Commercial |
$68.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$85.84
|
| Rate for Payer: Networks By Design Commercial |
$74.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.71
|
| Rate for Payer: Prime Health Services Commercial |
$97.28
|
| Rate for Payer: Prime Health Services Medicare |
$14.53
|
| Rate for Payer: Riverside University Health System MISP |
$15.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC SOM HMUCR ARSENIC/CREAT, RAND, U
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$191.88 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.88
|
| Rate for Payer: Blue Shield of California Commercial |
$7.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.80
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Central Health Plan Commercial |
$9.68
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$8.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.30
|
| Rate for Payer: EPIC Health Plan Senior |
$20.87
|
| Rate for Payer: Galaxy Health WC |
$10.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: Networks By Design Commercial |
$7.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Medicare |
$20.11
|
| Rate for Payer: Riverside University Health System MISP |
$20.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Other HMO |
$15.36
|
| Rate for Payer: United Healthcare HMO Rider |
$15.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.97
|
|
|
HC SOM HMUCR ARSENIC/CREAT, RAND, U
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
900915364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Central Health Plan Commercial |
$9.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.84
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: Galaxy Health WC |
$10.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: Networks By Design Commercial |
$7.87
|
| Rate for Payer: Prime Health Services Commercial |
$10.29
|
|
|
HC SOM HMUCR CADMIUM/CREAT, RAND, U
|
Facility
|
IP
|
$15.08
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900915365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.57 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Central Health Plan Commercial |
$12.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Senior |
$6.03
|
| Rate for Payer: Galaxy Health WC |
$12.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.31
|
| Rate for Payer: Networks By Design Commercial |
$9.80
|
| Rate for Payer: Prime Health Services Commercial |
$12.82
|
|
|
HC SOM HMUCR CADMIUM/CREAT, RAND, U
|
Facility
|
OP
|
$15.08
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900915365
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$233.96 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.96
|
| Rate for Payer: Blue Shield of California Commercial |
$9.50
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Central Health Plan Commercial |
$12.06
|
| Rate for Payer: Cigna of CA HMO |
$9.65
|
| Rate for Payer: Cigna of CA PPO |
$11.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.01
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$12.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$11.31
|
| Rate for Payer: Networks By Design Commercial |
$9.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.64
|
| Rate for Payer: Prime Health Services Commercial |
$12.82
|
| Rate for Payer: Prime Health Services Medicare |
$25.06
|
| Rate for Payer: Riverside University Health System MISP |
$26.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.15
|
| Rate for Payer: United Healthcare All Other HMO |
$19.15
|
| Rate for Payer: United Healthcare HMO Rider |
$19.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM HMUCR CREATININE, RAND, U
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$52.29 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.64
|
| Rate for Payer: Cigna of CA HMO |
$2.11
|
| Rate for Payer: Cigna of CA PPO |
$2.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$2.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM HMUCR CREATININE, RAND, U
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Central Health Plan Commercial |
$2.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.32
|
| Rate for Payer: EPIC Health Plan Senior |
$1.32
|
| Rate for Payer: Galaxy Health WC |
$2.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.48
|
| Rate for Payer: Networks By Design Commercial |
$2.15
|
| Rate for Payer: Prime Health Services Commercial |
$2.81
|
|
|
HC SOM HMUCR LEAD/CREAT, RAND, U
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900915367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Central Health Plan Commercial |
$6.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.09
|
| Rate for Payer: EPIC Health Plan Senior |
$3.09
|
| Rate for Payer: Galaxy Health WC |
$6.56
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.79
|
| Rate for Payer: Networks By Design Commercial |
$5.02
|
| Rate for Payer: Prime Health Services Commercial |
$6.56
|
|
|
HC SOM HMUCR LEAD/CREAT, RAND, U
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900915367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$122.43 |
| Rate for Payer: Adventist Health Commercial |
$1.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.06
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Central Health Plan Commercial |
$6.18
|
| Rate for Payer: Cigna of CA HMO |
$4.94
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.98
|
| Rate for Payer: EPIC Health Plan Senior |
$13.32
|
| Rate for Payer: Galaxy Health WC |
$6.56
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$5.79
|
| Rate for Payer: Networks By Design Commercial |
$5.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.11
|
| Rate for Payer: Prime Health Services Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM HMUCR MERCURY/CREAT, RAND, U
|
Facility
|
OP
|
$10.37
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900915366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$163.69 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6.53
|
| Rate for Payer: Blue Shield of California EPN |
$4.12
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Central Health Plan Commercial |
$8.30
|
| Rate for Payer: Cigna of CA HMO |
$6.64
|
| Rate for Payer: Cigna of CA PPO |
$7.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.83
|
| Rate for Payer: EPIC Health Plan Senior |
$17.89
|
| Rate for Payer: Galaxy Health WC |
$8.81
|
| Rate for Payer: Global Benefits Group Commercial |
$6.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.26
|
| Rate for Payer: Prime Health Services Commercial |
$8.81
|
| Rate for Payer: Prime Health Services Medicare |
$17.24
|
| Rate for Payer: Riverside University Health System MISP |
$17.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.17
|
| Rate for Payer: United Healthcare All Other HMO |
$13.17
|
| Rate for Payer: United Healthcare HMO Rider |
$13.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM HMUCR MERCURY/CREAT, RAND, U
|
Facility
|
IP
|
$10.37
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900915366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.37
|
| Rate for Payer: Central Health Plan Commercial |
$8.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.15
|
| Rate for Payer: EPIC Health Plan Senior |
$4.15
|
| Rate for Payer: Galaxy Health WC |
$8.81
|
| Rate for Payer: Global Benefits Group Commercial |
$6.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$7.78
|
| Rate for Payer: Networks By Design Commercial |
$6.74
|
| Rate for Payer: Prime Health Services Commercial |
$8.81
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
OP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$170.50 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11.29
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Central Health Plan Commercial |
$14.34
|
| Rate for Payer: Cigna of CA HMO |
$11.47
|
| Rate for Payer: Cigna of CA PPO |
$13.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.57
|
| Rate for Payer: EPIC Health Plan Senior |
$19.71
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.01
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.92
|
| Rate for Payer: Prime Health Services Commercial |
$15.23
|
| Rate for Payer: Prime Health Services Medicare |
$19.00
|
| Rate for Payer: Riverside University Health System MISP |
$19.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14.52
|
| Rate for Payer: United Healthcare HMO Rider |
$14.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Vantage Medical Group Senior |
$17.92
|
|
|
HC SOM HOMOCYSTEINE
|
Facility
|
IP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.13 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Central Health Plan Commercial |
$14.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.17
|
| Rate for Payer: EPIC Health Plan Senior |
$7.17
|
| Rate for Payer: Galaxy Health WC |
$15.23
|
| Rate for Payer: Global Benefits Group Commercial |
$10.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: Networks By Design Commercial |
$11.65
|
| Rate for Payer: Prime Health Services Commercial |
$15.23
|
|
|
HC SOM HPV
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$266.23 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.11
|
| 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 |
$191.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.23
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| 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 HPV
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
