|
HC SOM MOGS FACS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
|
|
HC SOM MOGS FACS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.32
|
| Rate for Payer: Blue Shield of California Commercial |
$252.00
|
| Rate for Payer: Blue Shield of California EPN |
$158.80
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM MOGS FACS TITER
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.32
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM MOGS FACS TITER
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915462
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM MONKEYPOX DNA PCR
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM MONKEYPOX DNA PCR
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$314.82 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.80
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.45
|
| Rate for Payer: United Healthcare All Other HMO |
$41.45
|
| Rate for Payer: United Healthcare HMO Rider |
$41.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOM M PNEUMONIAE AB IGM S IFA
|
Facility
|
OP
|
$53.32
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900913940
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| 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 |
$33.59
|
| Rate for Payer: Blue Shield of California EPN |
$21.17
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Central Health Plan Commercial |
$42.66
|
| Rate for Payer: Cigna of CA HMO |
$34.12
|
| Rate for Payer: Cigna of CA PPO |
$39.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$45.32
|
| Rate for Payer: Global Benefits Group Commercial |
$31.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: Networks By Design Commercial |
$34.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$45.32
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Riverside University Health System MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM M PNEUMONIAE AB IGM S IFA
|
Facility
|
IP
|
$53.32
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900913940
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$47.99 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Central Health Plan Commercial |
$42.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.33
|
| Rate for Payer: EPIC Health Plan Senior |
$21.33
|
| Rate for Payer: Galaxy Health WC |
$45.32
|
| Rate for Payer: Global Benefits Group Commercial |
$31.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: Networks By Design Commercial |
$34.66
|
| Rate for Payer: Prime Health Services Commercial |
$45.32
|
|
|
HC SOM M PNEUMONIAE PCR
|
Facility
|
IP
|
$185.46
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900915468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$166.91 |
| Rate for Payer: Adventist Health Commercial |
$37.09
|
| Rate for Payer: Cash Price |
$185.46
|
| Rate for Payer: Central Health Plan Commercial |
$148.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.18
|
| Rate for Payer: EPIC Health Plan Senior |
$74.18
|
| Rate for Payer: Galaxy Health WC |
$157.64
|
| Rate for Payer: Global Benefits Group Commercial |
$111.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.09
|
| Rate for Payer: Multiplan Commercial |
$139.09
|
| Rate for Payer: Networks By Design Commercial |
$120.55
|
| Rate for Payer: Prime Health Services Commercial |
$157.64
|
|
|
HC SOM M PNEUMONIAE PCR
|
Facility
|
OP
|
$185.46
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
900915468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$37.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$116.84
|
| Rate for Payer: Blue Shield of California EPN |
$73.63
|
| Rate for Payer: Cash Price |
$185.46
|
| Rate for Payer: Cash Price |
$185.46
|
| Rate for Payer: Central Health Plan Commercial |
$148.37
|
| Rate for Payer: Cigna of CA HMO |
$118.69
|
| Rate for Payer: Cigna of CA PPO |
$137.24
|
| 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 |
$129.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$157.64
|
| Rate for Payer: Global Benefits Group Commercial |
$111.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.91
|
| 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 |
$117.77
|
| 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 |
$37.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$139.09
|
| Rate for Payer: Networks By Design Commercial |
$120.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$157.64
|
| 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 |
$111.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.28
|
| 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 M PROTEIN MASS FIX
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 0077U
|
| Hospital Charge Code |
900915454
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM M PROTEIN MASS FIX
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 0077U
|
| Hospital Charge Code |
900915454
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$265.55 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$43.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$191.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.55
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.66
|
| Rate for Payer: EPIC Health Plan Senior |
$47.77
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$71.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.20
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$43.43
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$46.04
|
| Rate for Payer: Riverside University Health System MISP |
$47.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.18
|
| Rate for Payer: United Healthcare All Other HMO |
$35.18
|
| Rate for Payer: United Healthcare HMO Rider |
$35.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$43.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.77
|
| Rate for Payer: Vantage Medical Group Senior |
$43.43
|
|
|
HC SOM MTB PCR COMPLEX SPUTUM
|
Facility
|
IP
|
$243.39
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Adventist Health Commercial |
$48.68
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Central Health Plan Commercial |
$194.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.36
|
| Rate for Payer: EPIC Health Plan Senior |
$97.36
|
| Rate for Payer: Galaxy Health WC |
$206.88
|
| Rate for Payer: Global Benefits Group Commercial |
$146.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.68
|
| Rate for Payer: Multiplan Commercial |
$182.54
|
| Rate for Payer: Networks By Design Commercial |
$158.20
|
| Rate for Payer: Prime Health Services Commercial |
$206.88
|
|
|
HC SOM MTB PCR COMPLEX SPUTUM
|
Facility
|
OP
|
$243.39
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$48.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$153.34
|
| Rate for Payer: Blue Shield of California EPN |
$96.63
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Cash Price |
$243.39
|
| Rate for Payer: Central Health Plan Commercial |
$194.71
|
| Rate for Payer: Cigna of CA HMO |
$155.77
|
| Rate for Payer: Cigna of CA PPO |
$180.11
|
| 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 |
$170.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$206.88
|
| Rate for Payer: Global Benefits Group Commercial |
$146.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$182.54
|
| Rate for Payer: Networks By Design Commercial |
$158.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$206.88
|
| 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 |
$146.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.03
|
| 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 MTB PCR SPUTUM
|
Facility
|
IP
|
$289.11
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$260.20 |
| Rate for Payer: Adventist Health Commercial |
$57.82
|
| Rate for Payer: Cash Price |
$289.11
|
| Rate for Payer: Central Health Plan Commercial |
$231.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$202.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Senior |
$115.64
|
| Rate for Payer: Galaxy Health WC |
$245.74
|
| Rate for Payer: Global Benefits Group Commercial |
$173.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$183.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$170.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.82
|
| Rate for Payer: Multiplan Commercial |
$216.83
|
| Rate for Payer: Networks By Design Commercial |
$187.92
|
| Rate for Payer: Prime Health Services Commercial |
$245.74
|
|
|
HC SOM MTB PCR SPUTUM
|
Facility
|
OP
|
$289.11
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$57.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$41.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$182.14
|
| Rate for Payer: Blue Shield of California EPN |
$114.78
|
| Rate for Payer: Cash Price |
$289.11
|
| Rate for Payer: Cash Price |
$289.11
|
| Rate for Payer: Central Health Plan Commercial |
$231.29
|
| Rate for Payer: Cigna of CA HMO |
$185.03
|
| Rate for Payer: Cigna of CA PPO |
$213.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$202.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.77
|
| Rate for Payer: EPIC Health Plan Senior |
$45.85
|
| Rate for Payer: Galaxy Health WC |
$245.74
|
| Rate for Payer: Global Benefits Group Commercial |
$173.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$183.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$216.83
|
| Rate for Payer: Networks By Design Commercial |
$187.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41.68
|
| Rate for Payer: Prime Health Services Commercial |
$245.74
|
| Rate for Payer: Prime Health Services Medicare |
$44.18
|
| Rate for Payer: Riverside University Health System MISP |
$45.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOM MTHFR MUTATION DETECTION
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900914663
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$65.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$332.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.40
|
| Rate for Payer: Blue Shield of California Commercial |
$119.70
|
| Rate for Payer: Blue Shield of California EPN |
$75.43
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Cigna of CA HMO |
$121.60
|
| Rate for Payer: Cigna of CA PPO |
$140.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.81
|
| Rate for Payer: EPIC Health Plan Senior |
$71.87
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$107.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.56
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$65.34
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Prime Health Services Medicare |
$69.26
|
| Rate for Payer: Riverside University Health System MISP |
$71.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.93
|
| Rate for Payer: United Healthcare All Other HMO |
$52.93
|
| Rate for Payer: United Healthcare HMO Rider |
$52.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.87
|
| Rate for Payer: Vantage Medical Group Senior |
$65.34
|
|
|
HC SOM MTHFR MUTATION DETECTION
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
900914663
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Central Health Plan Commercial |
$152.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$142.50
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC SOM M. TUBERCULOSIS PCR
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900912875
|
|
Hospital Revenue Code
|
306
|
| 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 M. TUBERCULOSIS PCR
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900912875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$41.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$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 |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.77
|
| Rate for Payer: EPIC Health Plan Senior |
$45.85
|
| 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 |
$68.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.85
|
| 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 |
$41.68
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$44.18
|
| Rate for Payer: Riverside University Health System MISP |
$45.85
|
| 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 |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOM MUMPS AB IGG CSF
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900911356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Central Health Plan Commercial |
$21.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.95
|
| Rate for Payer: Galaxy Health WC |
$23.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Networks By Design Commercial |
$17.80
|
| Rate for Payer: Prime Health Services Commercial |
$23.27
|
|
|
HC SOM MUMPS AB IGG CSF
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900911356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| 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 |
$17.25
|
| Rate for Payer: Blue Shield of California EPN |
$10.87
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Central Health Plan Commercial |
$21.90
|
| Rate for Payer: Cigna of CA HMO |
$17.52
|
| Rate for Payer: Cigna of CA PPO |
$20.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.53
|
| Rate for Payer: EPIC Health Plan Senior |
$14.36
|
| Rate for Payer: Galaxy Health WC |
$23.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Networks By Design Commercial |
$17.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.05
|
| Rate for Payer: Prime Health Services Commercial |
$23.27
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Riverside University Health System MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO |
$10.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MUMPS AB IGM CSF
|
Facility
|
IP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Central Health Plan Commercial |
$21.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10.95
|
| Rate for Payer: Galaxy Health WC |
$23.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Networks By Design Commercial |
$17.80
|
| Rate for Payer: Prime Health Services Commercial |
$23.27
|
|
|
HC SOM MUMPS AB IGM CSF
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900912679
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Adventist Health Commercial |
$5.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| 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 |
$17.25
|
| Rate for Payer: Blue Shield of California EPN |
$10.87
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Central Health Plan Commercial |
$21.90
|
| Rate for Payer: Cigna of CA HMO |
$17.52
|
| Rate for Payer: Cigna of CA PPO |
$20.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.53
|
| Rate for Payer: EPIC Health Plan Senior |
$14.36
|
| Rate for Payer: Galaxy Health WC |
$23.27
|
| Rate for Payer: Global Benefits Group Commercial |
$16.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$20.54
|
| Rate for Payer: Networks By Design Commercial |
$17.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.05
|
| Rate for Payer: Prime Health Services Commercial |
$23.27
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Riverside University Health System MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO |
$10.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MUR 85549
|
Facility
|
OP
|
$26.87
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
900914739
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Adventist Health Commercial |
$5.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.70
|
| Rate for Payer: Blue Shield of California Commercial |
$16.93
|
| Rate for Payer: Blue Shield of California EPN |
$10.67
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Central Health Plan Commercial |
$21.50
|
| Rate for Payer: Cigna of CA HMO |
$17.20
|
| Rate for Payer: Cigna of CA PPO |
$19.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.94
|
| Rate for Payer: EPIC Health Plan Senior |
$20.62
|
| Rate for Payer: Galaxy Health WC |
$22.84
|
| Rate for Payer: Global Benefits Group Commercial |
$16.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$20.15
|
| Rate for Payer: Networks By Design Commercial |
$17.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.75
|
| Rate for Payer: Prime Health Services Commercial |
$22.84
|
| Rate for Payer: Prime Health Services Medicare |
$19.88
|
| Rate for Payer: Riverside University Health System MISP |
$20.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.19
|
| Rate for Payer: United Healthcare All Other HMO |
$15.19
|
| Rate for Payer: United Healthcare HMO Rider |
$15.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.62
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
