|
HC SOM H PYLORI WITH CLARITHO RESISTANCE PCR
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87513
|
| Hospital Charge Code |
900915363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM H PYLORI WITH CLARITHO RESISTANCE PCR
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87513
|
| Hospital Charge Code |
900915363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$183.03 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.03
|
| 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 |
$43.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.92
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| 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 |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| 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 |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| 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 HROMOSOME ANALYSIS AMNIO
|
Facility
|
IP
|
$319.98
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$287.98 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$319.98
|
| Rate for Payer: Central Health Plan Commercial |
$255.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.99
|
| Rate for Payer: EPIC Health Plan Senior |
$127.99
|
| Rate for Payer: Galaxy Health WC |
$271.98
|
| Rate for Payer: Global Benefits Group Commercial |
$191.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$287.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$239.99
|
| Rate for Payer: Networks By Design Commercial |
$207.99
|
| Rate for Payer: Prime Health Services Commercial |
$271.98
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
|
OP
|
$319.98
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$287.98 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.95
|
| Rate for Payer: Blue Shield of California Commercial |
$201.59
|
| Rate for Payer: Blue Shield of California EPN |
$127.03
|
| Rate for Payer: Cash Price |
$319.98
|
| Rate for Payer: Cash Price |
$319.98
|
| Rate for Payer: Central Health Plan Commercial |
$255.98
|
| Rate for Payer: Cigna of CA HMO |
$204.79
|
| Rate for Payer: Cigna of CA PPO |
$236.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$271.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$223.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.99
|
| Rate for Payer: EPIC Health Plan Senior |
$127.99
|
| Rate for Payer: Galaxy Health WC |
$271.98
|
| Rate for Payer: Global Benefits Group Commercial |
$191.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$287.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$223.99
|
| Rate for Payer: Multiplan Commercial |
$239.99
|
| Rate for Payer: Networks By Design Commercial |
$207.99
|
| Rate for Payer: Prime Health Services Commercial |
$271.98
|
| Rate for Payer: Riverside University Health System MISP |
$127.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.98
|
| Rate for Payer: Vantage Medical Group Senior |
$271.98
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
|
IP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$27.87 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Central Health Plan Commercial |
$24.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.19
|
| Rate for Payer: Multiplan Commercial |
$23.23
|
| Rate for Payer: Networks By Design Commercial |
$20.13
|
| Rate for Payer: Prime Health Services Commercial |
$26.32
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
|
OP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$19.51
|
| Rate for Payer: Blue Shield of California EPN |
$12.30
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Central Health Plan Commercial |
$24.78
|
| Rate for Payer: Cigna of CA HMO |
$19.82
|
| Rate for Payer: Cigna of CA PPO |
$22.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$26.32
|
| Rate for Payer: Global Benefits Group Commercial |
$18.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$23.23
|
| Rate for Payer: Networks By Design Commercial |
$20.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$26.32
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
|
IP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$40.91 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$36.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.18
|
| Rate for Payer: EPIC Health Plan Senior |
$18.18
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Multiplan Commercial |
$34.09
|
| Rate for Payer: Networks By Design Commercial |
$29.54
|
| Rate for Payer: Prime Health Services Commercial |
$38.63
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
|
OP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.62
|
| Rate for Payer: Blue Shield of California Commercial |
$28.63
|
| Rate for Payer: Blue Shield of California EPN |
$18.04
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$36.36
|
| Rate for Payer: Cigna of CA HMO |
$29.09
|
| Rate for Payer: Cigna of CA PPO |
$33.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$38.63
|
| Rate for Payer: Global Benefits Group Commercial |
$27.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$34.09
|
| Rate for Payer: Networks By Design Commercial |
$29.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$38.63
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HSV AB SCREEN, IGM,S EIA
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900914087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$145.10 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Central Health Plan Commercial |
$12.74
|
| Rate for Payer: Cigna of CA HMO |
$10.19
|
| Rate for Payer: Cigna of CA PPO |
$11.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
| Rate for Payer: Networks By Design Commercial |
$10.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$13.53
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM HSV AB SCREEN, IGM,S EIA
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900914087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Central Health Plan Commercial |
$12.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.37
|
| Rate for Payer: EPIC Health Plan Senior |
$6.37
|
| Rate for Payer: Galaxy Health WC |
$13.53
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
| Rate for Payer: Networks By Design Commercial |
$10.35
|
| Rate for Payer: Prime Health Services Commercial |
$13.53
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
|
OP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$7.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.66
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Central Health Plan Commercial |
$9.40
|
| Rate for Payer: Cigna of CA HMO |
$7.52
|
| Rate for Payer: Cigna of CA PPO |
$8.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.51
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.19
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
| Rate for Payer: Prime Health Services Medicare |
$13.98
|
| Rate for Payer: Riverside University Health System MISP |
$14.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
|
IP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Central Health Plan Commercial |
$9.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$9.99
|
| Rate for Payer: Global Benefits Group Commercial |
$7.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: Networks By Design Commercial |
$7.64
|
| Rate for Payer: Prime Health Services Commercial |
$9.99
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.62
|
| Rate for Payer: Blue Shield of California Commercial |
$10.87
|
| Rate for Payer: Blue Shield of California EPN |
$6.85
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Central Health Plan Commercial |
$13.80
|
| Rate for Payer: Cigna of CA HMO |
$11.04
|
| Rate for Payer: Cigna of CA PPO |
$12.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$14.66
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Central Health Plan Commercial |
$13.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.90
|
| Rate for Payer: EPIC Health Plan Senior |
$6.90
|
| Rate for Payer: Galaxy Health WC |
$14.66
|
| Rate for Payer: Global Benefits Group Commercial |
$10.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: Networks By Design Commercial |
$11.21
|
| Rate for Payer: Prime Health Services Commercial |
$14.66
|
|
|
HC SOM HTGFN 84432
|
Facility
|
IP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
|
|
HC SOM HTGFN 84432
|
Facility
|
OP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$165.66 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.66
|
| Rate for Payer: Blue Shield of California Commercial |
$103.24
|
| Rate for Payer: Blue Shield of California EPN |
$65.06
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Cigna of CA HMO |
$104.88
|
| Rate for Payer: Cigna of CA PPO |
$121.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.50
|
| Rate for Payer: EPIC Health Plan Senior |
$17.67
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.06
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.02
|
| Rate for Payer: Riverside University Health System MISP |
$17.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Vantage Medical Group Senior |
$16.06
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
|
OP
|
$127.57
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$195.76 |
| Rate for Payer: Adventist Health Commercial |
$25.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.76
|
| Rate for Payer: Blue Shield of California Commercial |
$80.37
|
| Rate for Payer: Blue Shield of California EPN |
$50.65
|
| Rate for Payer: Cash Price |
$127.57
|
| Rate for Payer: Cash Price |
$127.57
|
| Rate for Payer: Central Health Plan Commercial |
$102.06
|
| Rate for Payer: Cigna of CA HMO |
$81.64
|
| Rate for Payer: Cigna of CA PPO |
$94.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$108.43
|
| Rate for Payer: Global Benefits Group Commercial |
$76.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Networks By Design Commercial |
$82.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$108.43
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
|
IP
|
$127.57
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$114.81 |
| Rate for Payer: Adventist Health Commercial |
$25.51
|
| Rate for Payer: Cash Price |
$127.57
|
| Rate for Payer: Central Health Plan Commercial |
$102.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.03
|
| Rate for Payer: EPIC Health Plan Senior |
$51.03
|
| Rate for Payer: Galaxy Health WC |
$108.43
|
| Rate for Payer: Global Benefits Group Commercial |
$76.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Networks By Design Commercial |
$82.92
|
| Rate for Payer: Prime Health Services Commercial |
$108.43
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.95
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.11
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$10.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$10.95
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM HUMAN HERPESVIRUS-6 PCR
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 87533
|
| Hospital Charge Code |
900912711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$306.42 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$41.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.76
|
| 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 |
$94.50
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.94
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.96
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41.76
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.27
|
| Rate for Payer: Riverside University Health System MISP |
$45.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.82
|
| Rate for Payer: United Healthcare All Other HMO |
$33.82
|
| Rate for Payer: United Healthcare HMO Rider |
$33.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Vantage Medical Group Senior |
$41.76
|
|
|
HC SOM HUMAN HERPESVIRUS-6 PCR
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 87533
|
| Hospital Charge Code |
900912711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM HYPOGLYCEMIC AGENT SCREEN
|
Facility
|
OP
|
$101.03
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
900912528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$209.79 |
| Rate for Payer: Adventist Health Commercial |
$20.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$150.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.79
|
| Rate for Payer: Blue Shield of California Commercial |
$63.65
|
| Rate for Payer: Blue Shield of California EPN |
$40.11
|
| Rate for Payer: Cash Price |
$101.03
|
| Rate for Payer: Cash Price |
$101.03
|
| Rate for Payer: Central Health Plan Commercial |
$80.82
|
| Rate for Payer: Cigna of CA HMO |
$64.66
|
| Rate for Payer: Cigna of CA PPO |
$74.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.41
|
| Rate for Payer: EPIC Health Plan Senior |
$40.41
|
| Rate for Payer: Galaxy Health WC |
$85.88
|
| Rate for Payer: Global Benefits Group Commercial |
$60.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.72
|
| Rate for Payer: Multiplan Commercial |
$75.77
|
| Rate for Payer: Networks By Design Commercial |
$65.67
|
| Rate for Payer: Prime Health Services Commercial |
$85.88
|
| Rate for Payer: Riverside University Health System MISP |
$40.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.52
|
| Rate for Payer: United Healthcare All Other HMO |
$50.52
|
| Rate for Payer: United Healthcare HMO Rider |
$50.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.88
|
| Rate for Payer: Vantage Medical Group Senior |
$85.88
|
|
|
HC SOM HYPOGLYCEMIC AGENT SCREEN
|
Facility
|
IP
|
$101.03
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
900912528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$90.93 |
| Rate for Payer: Adventist Health Commercial |
$20.21
|
| Rate for Payer: Cash Price |
$101.03
|
| Rate for Payer: Central Health Plan Commercial |
$80.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.41
|
| Rate for Payer: EPIC Health Plan Senior |
$40.41
|
| Rate for Payer: Galaxy Health WC |
$85.88
|
| Rate for Payer: Global Benefits Group Commercial |
$60.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$75.77
|
| Rate for Payer: Networks By Design Commercial |
$65.67
|
| Rate for Payer: Prime Health Services Commercial |
$85.88
|
|
|
HC SOM IA2 AB
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900914354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
